my boss discourages us from using our health insurance

by Alison Green on April 30, 2018

A reader writes:

I work for a small tech startup in a large city. We have about 80 employees in the United States who are all fairly young and healthy. Recently, our CEO has started using our weekly company-wide meetings to direct people how and how not to use our company’s health insurance policy.

His argument is that we are lucky because individual premiums are low and therefore employees shouldn’t be utilizing insurance in a frivolous ways that will drive up cost. In fact, he’s started sharing articles about how chiropractic medicine has no scientific evidence of its effectiveness in the treatment of pain. He also keeps telling stories about how he once sought treatment for a medical condition and refused to get something biopsied because of the cost. It makes me feel very uncomfortable.

Now, because I work under the business operations function of the company (no formal HR), he has asked me to put together a guide about how insurance works to include topics like how to pick a “competent doctor” and “how to stay healthy and exercise (and how this benefits the company).” In startups like ours where everyone has equity, I know he feels like this is going to help everyone, in the long run, to keep costs down but I can’t help feeling like this is wrong.

Ick, yeah, discouraging employees from using their health care when it’s needed — like getting something biopsied! — is shady as hell.

The specific guides he’s asked you to put together don’t sound terribly outrageous on their own — and in fact aren’t that different from more traditional wellness initiatives that many companies run for exactly this same reason — but of course that depends on what the content ends up being. And I’m sure your health plan has existing documents that could be used (and if they don’t, certainly major medical associations do), so the fact that he wants you to write these yourself instead makes me suspect he’ll want to include more skewed advice. But I think your best bet here is to find some versions of these that already exist from mainstream sources and suggest that they’ll be far more credible than something the company creates on its own.

And if you or your coworkers are in a position to, you should also tell him that discouraging employees from legitimate uses of health insurance is coming across as sketchy and unprofessional and is likely to create major cynicism and mistrust toward him and the company.

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    1. Trout 'Waver*

      Well, chiropractors aren’t any better than placebo in the controlled studies performed. But placebo is a actually pretty effective at some types of chronic pain, so ymmv.

      1. Health Stuff*

        My partner is a medical professional who warned me that sometimes people are literally injured from chiropractors so it’s not as risk free as just being a placebo. But clearly the point of the letter is that people have the right to look into this themselves and make their own health decisions.

        1. Observer*

          That doesn’t mean it doesn’t work. You DO need to make sure that you are seeing a competent practitioner and that you have a correct diagnosis. Otherwise, you’re asking for trouble.

          1. Health Stuff*

            The problem is that it’s both – there is no medical “diagnosis.” It’s “alternative medicine” that isn’t backed by scientific evidence. On top of that the adjustments that chiropractors do may cause harm, so essentially it’s doing more harm than good. Like I said though, people have the right to do their own research about their own practitioners and decide what they want to do. I’m not saying that literally everyone who goes to a chiropractor gets injured, and I don’t doubt there are people that enjoy the readjustments, but people should inform themselves of the risk and know it is not considered medicine.

            1. Observer*

              Chiropractic is not a diagnosis, just as physical therapy is not a diagnosis, nor is aspirin, etc.

              Just because something is “alternative” doesn’t mean it doesn’t have scientific basis.

              1. Technical_Kitty*

                Uh, yes it does. Alternative medicine has little/no scientific support, else it wouldn’t have “alternative” in front of medicine.

                1. Observer*

                  That’s not true. Most non-allopathic medical care is considered “alternative”. That doesn’t mean it doesn’t work / is unscientific.

                2. Michaela*

                  Uh, ‘allopathic’ literally means ‘scientifically backed.’

                  Your sentence can be rewritten as: “Most non-scientific medical care is considered “alternative”. That doesn’t mean is non-scientific.”

                  The term for ‘scientifically-validated alternative medicine’ is just, ‘medicine.’

                3. Observer*

                  Uh, ‘allopathic’ literally means ‘scientifically backed.’

                  Not according to Merriam Webster: medical Definition of allopathy. plural allopathies. 1 : a system of medical practice that aims to combat disease by use of remedies (as drugs or surgery) producing effects different from or incompatible with those produced by the disease being treated — compare homeopathy.

                4. Jules the Third*

                  What Micaela said.

                  Observer, you’re conflating ‘scientifically backed’ and ‘effective’. Some ‘scientifically backed’ medicine isn’t effective as commonly prescribed (eg, SSRIs for depression), and some ‘non-scientifically backed’ medicine may be effective (eg, pot or ecstasy for anxiety). The thing is:
                  Scientifically backed medicine has a better history of effectiveness.
                  Scientifically backed medicine has much better documentation of side effects and adverse reactions. This can help you make better care decisions.

                  You can choose anything that makes you feel better. I just like to know what risks I’m running (sez the woman who’s managed to hit 9 out 10 metformin side effects, including B12 blocking. sigh.)

                5. Observer*

                  The term “alternative” has nothing to do with scientific backing, much less actual usefulness.

                6. Another Human*

                  If you think SSRI’s aren’t effective for depression, you’ve never actually taken them. I was much better off when I was able to take them. I can’t stand it when people denigrate medicines people actually need to have better lives.

              2. ket*

                “Diagnosis” and “treatment” are different things. You seem to be trying to class chiropractic care with aspirin, in that many people use both without ever seeing an MD and without getting a diagnosis for a health problem, and they make some people feel better and don’t help or actually injure others. That is fine — same is true for jogging, crystals, meditation, prayer, and drinking a lot of wine. With all the above and anything else in life, you need to look at the possible risks and possible benefits.

                The fact that something makes you feel better is completely decoupled from 1) whether it’s medicine, or 2) whether it has a scientific basis. Prayer helps a lot of people. It’s not medicine or science, and the fact that it is neither of those doesn’t invalidate its effectiveness in helping many people gain clarity, courage, and solace. When people confuse prayer and medicine, say by claiming all cancer can be cured with prayer, the results are generally not effective for the stated goal.

                Chiropractic has some evidentiary support for some conditions. I tried it myself for a breech baby (Webster maneuver). One problem is that it’s so practitioner-dependent that it’s hard to test scientifically. If you find someone with a good safety record who makes you feel better, then you feel better — great! Just don’t substitute it for medicine when you need medicine. And don’t necessarily expect insurance to pay for it.

                1. Observer*

                  I’m not the one who is conflating the treatment and diagnosis. The fact is that both aspirin and chiropractic are treatments, and neither is a diagnosis. The post I was responding to tried to claim that chiropractic is a diagnosis. That’s nonsense and the rest of the claims in that post that are based on that notion are nonsense as well.

                  I happen to agree with you that chiropractic is often pushed for conditions where it’s totally not the solution. That doesn’t negate the situations where it is appropriate.

                  Also, the issue here is not whether insurance should cover it. The issue is that insurance already DOES cover it (probably because the insurer has reason to believe that it’s the most cost effective thing for them) and the boss is trying to prevent people from using their health benefits.

                  And we know that the boss is either too ignorant to pay attention to, or will flat out lie about the effectiveness / health benefits of anything. We know this because he ALSO claimed that getting something biopsied is a waste of money.

              3. Michaela Westen*

                The medical establishment is *extremely* resistant to accepting new things – especially things that can’t be confirmed in double-blind placebo-controlled studies – which really work only for drugs.
                There are therapies that are considered alternative that do work and are science-based, but since the medical estabilshment hasn’t accepted them, are considered alternative.
                Especially with chiropractic – how much more obvious can it be? A person has musculoskelatal problems – a competent chiropractor aligns their bones and muscles – resolves the problem.
                And yet, the medical establishment *still* hasn’t fully accepted this. *eye roll*

                1. lew*

                  This is mistake in two ways. First is that the supposed mechanisms for why chiropractic work (‘subluxations’) are nonsense with no basis in physical reality. Second is that chiropractors often make claims that go wayyyy beyond musculoskeletal problems. One CBC News investigation in Canada found dozens of chiropractors’ websites claiming to treat: autism, Tourette’s, Alzheimer’s, colic, infections, and cancer. Also false claims like vaccination causes autism and that a chiropractor’s training is “virtually identical” to that of a medical doctor. So, they recommend incorrect treatments and, even when possibly effective, are just coincidentally so–because the mechanisms driving them are wrong.

                2. whingedrinking*

                  The medical establishment is *extremely* resistant to accepting new things – especially things that can’t be confirmed in double-blind placebo-controlled studies –
                  That is a feature, not a bug.

                3. Michaela Westen*

                  “First is that the supposed mechanisms for why chiropractic work (‘subluxations’) are nonsense with no basis in physical reality.”
                  No, you’re not biased!!!

                4. Michaela Westen*

                  I completely agree that chiropractors should *not* claim to treat or cure things outside their scope. I’m having trouble finding a new one because they all seem to be trying to do stuff like this instead of what I need, a back adjustment.

              4. whingedrinking*

                Just because something is “alternative” doesn’t mean it doesn’t have scientific basis.
                Actually it does. Remember that “scientific” doesn’t mean “effective” – it means “we’ve studied this like A LOT under controlled conditions and gotten the same results every time”. That’s why it’s called evidence-based medicine. An alternative treatment might have some kind of therapeutic value, but it hasn’t been studied.

              5. Specialk9*

                I have asked traditional doctors for vitamin tests for literally years without luck, but my Integrative Medicine MD ordered them without problem. Turns out I had very low vitamins that were influencing energy production. Bumped up those vitamins, and have had a significant improvement.

                So… Scientifically proven *vitamins* are too “out there” for traditional medicine? Because, what, they have only been studied and proven for over 200 years? It’s ridiculous. Vitamins shouldn’t be considered woo-woo, docs.

                Sometimes alternative medicine – that gigantic umbrella – is both scientific and non-mainstream, like with Integrative Medicine MDs and Doctors of Osteopathy (DOs). Sometimes it’s quackery and nonsense. Sometimes it’s right and science hasn’t caught up yet. Sometimes it’s devastatingly wrong.

        3. Anion*

          Yes, people have actually died. And as Trout ‘Waver said, it’s no better than placebo.

          I have no issue with a boss mentioning that chiropractors are (on a scientific basis) useless, but wouldn’t it be better if he simply went with an insurance plan that didn’t cover them, instead of shaming people who might use them? It sounds to me like his message is right but his delivery wasn’t.

          1. Ego Chamber*

            “but wouldn’t it be better if he simply went with an insurance plan that didn’t cover them,”

            Ikr. The only logical explanation I could figure is someone got a bad adjustment at the chiropractor, fucked up their back really bad, and is now using their insurance to get it taken care of, which is upsetting the boss because it’s unnecessary medical care that “could have been avoided.” ;P

      2. Observer*

        It depends for what. It’s true that chiropractic gets over-sold. On the other hand, there are areas where it makes a lot of sense.

        1. Chinook*

          As someone who saw a chiropractor for back and hip pain due to joint issues, I can report that it worked for that specific issue for me because my spine misalignment was the cause of the issue, but I also know enough science to realize that it won’t fix most thing. It is like saying that a cast on my wrist helped fix it when I broke it so it should also cure my wrist pain from carpal tunnel syndrome. The body doesn’t work that way.

          But telling employees that they can’t use their benefits seems shady to me. OP, does your boss also encourage them to not use all their vacation time or to work for regular rates on stat. holidays? In my mind, they are the same thing. I am willing to accept less salary if it means I better benefits plan that allows for full coverage of therapeutic massages, and if my boss then told me to stop doing that, then I would negotiate a higher wage.

        2. JM60*

          There are reasons why the American Medical Association has called chiropracty a “Pseudosciencltific cult.” I’ve heard that there’s been an emphasis on evidence based approachs in chiropracty as of lately, so maybe this cheracterization is unfair. However, it’s probably a good idea to consider seeing orthopedic MDs or DOs before seeing a chiropractor.

          1. Observer*

            Yes, there are a lot of reasons and good reason to believe that not all of them are totally scientific.

            Having said that, I do agree that seeing a good orthopedist, or even a good internist / GP is a good idea. A chiropractor is not likely to cure your constipation, even though it’s the cause of your backache. (And, yes that actually happens.) So, good diagnosis is the key.

          3. jo*

            I’m here to evangelize for physical [and occupational] therapists (my sister and mother, respectively, work in those professions)! If you have pain or musculoskeletal problems, and your insurance doesn’t require you to get a referral before seeing a PT, go ahead and see one. They’ll “realign” you gradually and in a lasting way, and will give you maintenance techniques for the long term, as opposed to the quick, temporary fixes (which you have to keep coming back for over and over) that many chiropractors dispense. And a good PT will know when to say, “this is beyond the scope of my work and you might even need surgery, see an orthopedist.”

        3. Anon Today*

          My granddad was a chiropractor. He practiced for more than 50 years. He had a better knowledge of anatomy that any physician that I ever met. But, at the same time he knew what was beyond his scope of abilities, and he didn’t try and be a physician. So I think chiropractic care can be really worthwhile, but I do think you have to careful with who you use, because like all health professionals there are some that are shady.

          I’ll also say that in 50 years, my granddad never had one medical malpractice suit filed against him.

          1. Gatomon*

            +1

            I would recommend my chiropractic office, they typically stick to their back pain fixes. I wouldn’t recommend the office down the road that claims to help you lose weight through adjustments. Since a lot of plans won’t cover adjustments (or limit the number you can get) I guess some doctors turn to additional revenue streams to stay in business. I used to see a younger chiropractor and he told me his educational debt was something like $200k, akin to an MD.

            Personally I don’t think it’s any more wacky that massage therapy or physical therapy. I do believe it works, both on myself, on friends and family I’ve seen treated and even a dog. (The dog came in limping to the waiting room, and the doctor came out with a small tool, made a quick adjustment to the dog’s back and the limp was totally gone.)

      3. Will!*

        Also, the placebo is not just the benefit you get from feeling treated. That’s part of, but a small part. A bigger part, especially when it comes to pain alleviation, is that chronic diseases go in cycles–good days and bad days–and you’re most likely to seek treatment on a bad day. When the pain recedes and you have a good day, that may be from a therapy or it may be from the nature of the disease.

        *That’s* the placebo effect–all the stuff that isn’t necessarily attributable to a given therapy.

        2. Snark*

          The placebo effect is also some very potent psychosomatic effects that contribute to a real reduction in pain and other symptoms.

      4. Health Insurance Nerd*

        As a last resort for my daughters scoliosis, I took her to a chiropractor who was convinced they could reduce the curvature of her spine. Their office signage stated that people who see a chiropractor don’t get cancer, and that vaccinations were poison. A year and several thousand dollars later her curve was no better, and we stopped going. One of the “doctors” also told a patient that he could cure his girlfriends sea sickness with chiro, so yeah.

        (to be clear, I know people who have had positive experiences and outcomes with chiro, but I am just not a believer based on my family’s experience.)

        1. Elizabeth West*

          That person was a quack and had no business practicing anything.
          Anybody who does this should be shut down immediately and prevented from opening any kind of clinic or practice until the end of time.

        2. Michaela Westen*

          1. A chiropractor that makes unproven claims like that is a quack and should be shut down. A legitimate chiropractor doesn’t make such claims!!! These quacks give all their profession a bad name. :(
          2. Did you ever hear of the Gokhale method for back problems? The lady who developed it wrote a book called “8 Steps to a Pain-Free Back”. In this book she tells of a patient with scoliosis who was helped by her method.
          I’ve been told there are practitioners trained in her method, maybe they could help your daughter? Or she herself if you live in the same area?

          1. Health Stuff*

            So, this is taken from Wikipedia but appears to be well sourced. “Chiropractic has two main groups: “straights”, now the minority, emphasize vitalism, “innate intelligence” and spinal adjustments, and consider vertebral subluxations to be the cause of all disease; “mixers”, the majority, are more open to mainstream views and conventional medical techniques, such as exercise, massage, and ice therapy.”

            So there’s a whole scene, granted seems to be a minority, of chiropractors who are “quacks.”

        3. Observer*

          So, you unfortunately were fleeced by a scammer. I don’t know if scoliosis is amenable to chiro, but I DO know that any practitioner who advocates against vaccines should be shut down. And anyone who claims that chiropractic prevents cancer is a liar or incompetent idiot.

          1. Mairona*

            As I mentioned in another comment, chiropractic has almost completely corrected my scoliosis – but it’s been gradual, over several years, and I picked my chiros VERY carefully. No “chiro is a cure-all” BS artists and they must be willing to refer to a physician/specialist if necessary. If they start claiming they can cure cancer with spinal manipulation or that they can pull toxins out of my feet with a foot spa, I’m out the door.

            In any case, seeing a (legit) chiropractor once every few weeks for a few years beats the hell out of spinal surgery or uncomfortable corrective braces.

        4. many bells down*

          The problem is it’s so hard to determine which chiropractors are good and which are “spinal adjustments cure AIDS, cancer, and infertility.” I see an osteopath now instead when I think I have a musculoskeletal problem, because you have to actually go to medical school for that.

        5. Oranges*

          I believe there are some actual good studies done on chiro and the main take away that I remember was that it helped with lower back pain. Everything else couldn’t clear the bar of “we’re pretty sure this isn’t placebo effect”. So if I ever have lower back pain I might see a chiropractor.

          Everything else… I’ll find a less expensive placebo please.

      5. Michaela Westen*

        Common sense – a person’s spine gets pulled out of alignment by daily wear and tear. Over time this can lead to bigger problems like the back seizing up.
        A chiropractor fixes this.
        I’ve been going to chiropractors since the 80’s. They’ve treated minor injuries and kept my back and shoulders functioning well. Once when I didn’t go for five years my back seized up! I thought that only happened on TV! My doctor prescribed muscle relaxers. My chiropractor fixed the problem.

        You do have to be careful about finding a good, no-nonsense chiropractor. It’s not good that chiropractic has become so enmeshed with questionable therapies (acupunture can be good, but the others…). Two days ago I tried one in my neighborhood and she was so flaky I left without letting her treat me.
        If the medical establishment had accepted the place chiropractors have in treating people and allowed them in, they might not have gotten so enmeshed with alternative therapies.
        I have an appointment today at a practice that specializes in sports-related. At least they’re not likely to be flaky. Fingers crossed…

        1. Michaela*

          Your entire first sentence is medically accurate, despite being ‘common sense.’ It turns out ‘common sense’ is actually a really bad guide to what works, medically speaking.

          1. Michaela Westen*

            It has always worked better for me than relying on experts. If I hadn’t learned to think for myself and figure out how to manage my health and diagnose my own allergies, I would have had a miserable life because the MDs were *not* doing any of this.

            1. WannaAlp*

              But what you were doing doesn’t sound like common sense at all: you had to figure out for yourself what worked for you and your body. If common sense was all it took, you wouldn’t have had to figure things out. You sound more like you have been doing your own little bit of science, with empirical experiments on your own body, with a data set of size 1.

              I’m hugely pro-science, but unfortunately mainstream medicine doesn’t cover everything (I too have found them to be rubbish at allergies, and have been forced into using alternative medical facilities), nor is mainstream medicine always as evidence-based and unbiased by “common” sense as it thinks it is , e.g. prescribing treatments that have very temporary and/or low success rates and/or are dangerous.

              1. Michaela Westen*

                Yes, I agree. I believe the first step is common sense. Think logically: What is likely to work? What is not likely to? What have I already tried? What worked and what didn’t? and build on that.
                That’s what I mean by common sense. Many Americans don’t do this with their health, their work, their education… It’s not really taught in schools or our culture… it works for me.

                1. Sue Wilson*

                  because that’s not common sense that’s critical thought, which is an actual skill that needs to be taught

                3. MelfinatheBlue*

                  If you’re looking for a place it’s taught, may I refer you to my physics BA? Learning to think like that is the reason (or so I was told) premeds have to take intro physics. It’s incredibly useful (or at least has been for me) in IT, and generally in life. I even use it on humans (in combination with empathy, either to understand why someone’s doing or saying X or to predict and avoid strong emotions I’ll end up experiencing (strong empathy’s a bitch like that)).

      6. Mairona*

        I’ve been seeing a chiropractor for scoliosis ever since a scoliosis specialist at Emory told me that I wasn’t a candidate for corrective surgery (not severe enough) and that I should manage my pain with physical therapy (which I was already doing and not seeing much progress) and ibuprofen (which I was already popping like candy). I’m very careful when choosing a chiropractor because there ARE quacks who try to sell you on chiropractic being a cure-all and/or push anti-vax and other BS. I will only see a chiropractor who is realistic about what they can and can’t do, and are willing to refer patients to a medical doctor if necessary.

        It’s paid off. I used to have excruciating back and neck pain, as well as thunderclap headaches at least once a week. I have far less back pain far less often and haven’t had a thunderclap headache in years. My current and previous chiropractors both counselled me on exercises to strengthen my back muscles, which have effectively reduced the frequency of my visits. According to my x-rays, my curvature is much improved, to the point of almost being gone. If nothing else, the x-rays did it for me.

    2. Marillenbaum*

      After getting into a car accident and ending up with third-degree whiplash, my chiropractor was SO incredibly helpful in getting me back to normal. I would have sent him cookies if that wouldn’t have been totally weird.

      1. Phoenix Programmer*

        Yeah. I avoided chiropractic after my car accident and really regretted it. I had heard it was bumbkiss. Then we hired an activator chiropractor and I heard so many good things. It had been 3 years since the accident at this point and despite a year of (very expensive) physical therapy I still had hip pain. She did not and could not have known about the accident (different state and I did not transfer med records). I decided to let her be blind through my eval as a test. After a 45 minute eval she identifies the whiplash trauma and asked if I had been in an accident. After a month working with her the pain in my hip went away and stayed away. I go to her for pain first. Occasionally she refers to PT if her adjustments don’t work.

        1. Anonyna*

          So unrelated but every time I see your name I’m tempted to ask, and now Imma just do it. Phoenix programmer as in…Phoenix pay system by any chance?

          1. Chinook*

            With luck, Phoenix programmer is just in Arizona and not at all connected to Canadian payroll issues.

          2. Phoenix Programmer*

            I had no idea there was a program called Phoenix! Honestly it is just that iidenrify with the Phoenix and love programming.

        1. anon for this*

          Do you think you can put a note at the end of your response or at the top of the comments because people are going to keep derailing about what they think should/shouldn’t be covered under health insurance and what they think are legitimate opinions about medicine. I know this happens every time we have a medical question, but I’m honestly tired of seeing this debate when it’s not really helpful to the letter writer.

      4. Michaela Westen*

        Since OP’s boss is specifically telling people not to use chiropractic, I think it’s relavant. It’s giving OP examples of cases where chiropractic was helpful.

        1. Observer*

          To be honest, I have to disagree. I admit that I’ve allowed myself to get into the derail, but fundamentally it’s not really relevant. Because, firstly, the boss should not be trying to stop people from using benefits that are already covered – the letter is not about WHETHER to cover chiropractic or any other treatment, but whether to allow people to use their coverage. Or rather how to get the boss to stop interfering.

          Also, chiropractic is not the only thing the boss is trying to prevent the staff from using. So, the OP really, really doesn’t even need to go there.

          1. Michaela Westen*

            Thanks, I respect your opinion. :) My thought is that having good examples could prevent the boss from having undue influence over the employees and help them decide for themselves.

      5. Princess Consuela Banana Hammock*

        It was very long, and it was very derailing/unhelpful.

    4. Snark*

      It’s none of his business what treatments his employees and their chosen, insurance-covered medical practitioners decide are the best medical care for them. I’m personally not sure chiropractic should be covered by insurance, because he’s not incorrect that the evidence for its effectiveness tends to be anecdotal rather than clinical and rigorous – but that’s completely beside the point. This argument stops and starts at, it’s 100% not his business to try to micromanage employees’ personal medical decisions.

      1. Health Stuff*

        +100 – he’s not wrong substantively about that, and more people should look into it since sometimes it does more harm than good, but that’s up for individuals to decide, and not him.

        1. Snark*

          Yep. Whatever we all think about it, the point is, this guy needs to get his nose out of medical decisions whether he agrees with them or not. And if he’s so worried about the costs of providing a near-universal benefit, then he needs to not be in business, because this is a cost of it.

          1. neverjaunty*

            Exactly this. And given his not very subtle hints that employees maybe shouldn’t be using their insurance for things like biopsies, it’s pretty clear his true concern isn’t evidence-based treatment.

        2. Specialk9*

          “My body my choice” applies to men too. It just gets forgotten because it’s rare for people in power to try to take away a man’s choices like they do a woman’s choices. But this is the perfect example of how it does still happen! People in power try to curtail choices to fit their own desires – here for the bottom dollar.

      2. Quack quack*

        “I’m personally not sure chiropractic should be covered by insurance, because he’s not incorrect that the evidence for its effectiveness tends to be anecdotal rather than clinical and rigorous – but that’s completely beside the point.”

        It’s at the heart of the point. The company should not feel obligated to offer health insurance that covers quack treatments. (Now, if the insurance plans that the company has selected cover chiropractors, then it’s none of the CEO’s business whether insured take advantage of that benefit. But he would be entirely within his rights to nix insurance plans that are more costly to the company because they cover chiropractors.)

        1. Observer*

          Well, quite obviously chiropractic coverage is not making the plan more expensive, because the OP states that at the moment premiums are low.

          1. JM60*

            I think this is fallacious reasoning. Just because premiums are low doesn’t mean that they wouldn’t be even lower without chiropractic coverage.

        2. anon for this*

          Can we not get into another derailed discussion about how medical practices people here don’t agree with are “quack treatments”. It’s condescending and rude towards those who do find some benefit from them. You don’t have to agree with them, but if they’re not forcing those methods on you, it’s a jerk move to make fun of them for something that may give them relief.

          1. Quack quack*

            Can we not get into another derailed discussion about how medical practices people here don’t agree with are “quack treatments”.

            See, there’s this thing called “data” and the “scientific method” that we use to assess the effectiveness of medical treatments. You don’t make major policy decisions on whether Aunt Susie is fond of her chiropractor. And while Aunt Susie is perfectly entitled to do what she wants with her own money, she shouldn’t expect companies to subsidize her decisions absent real data about the effectiveness of chiropractic treatment.

            And your “rude and condescending” is my “putting hands over ears and singing ‘la la la, I can’t hear you” way of avoiding a tough discussion.

            1. anon for this*

              All I asked is that you’re not rude towards people who might find some use in those methods, but apparently that’d beyond you. I know the difference between data and scientific method, but thanks for so condescendingly explaining it to me as though I were an idiot.

              1. JM60*

                Pointing out that something is quackery is not necessarily rude. It may be rude depending on context and how it’s done. However, as a society, it’s really important that we be able to talk about quackery, even if, and especially if, some people think that that quackery is helping them. Shutting down discussions of quackery because of ‘rudeness’ can allow dangerous quackery to survive and thrive.

        3. Snark*

          “It’s at the heart of the point. The company should not feel obligated to offer health insurance that covers quack treatments”

          I wasn’t looking to be corrected. If he does not want to offer insurance that covers chiropractic, he can select a different plan with different coverage, but he is not entitled to shame or dictate to his employees what covered treatments they can or should pursue. That is a Boss problem, not an Employee problem, and whose problem it is, is in fact the heart of the point I was making. Make your own point if you want.

          1. Quack quack*

            “I wasn’t looking to be corrected. If he does not want to offer insurance that covers chiropractic, he can select a different plan with different coverage, but he is not entitled to shame or dictate to his employees what covered treatments they can or should pursue.”

            Then you were not being corrected, since that is exactly what I said.

            1. Yolo*

              “I was not looking to be corrected” is exactly the kind of thing that makes people want to stop commenting here. No one is looking to be corrected, we’re trying to have a conversation about the job-related issues in the letter.

              2. Snark*

                Well, frankly, I found their tone presumptuous and condescending, which is a lot more corrosive to conversation than a tart reminder to not do that.

                And Louise, are you looking to butt heads with me? Because I’ve been very consciously giving you space lately, and it’s annoying that you refuse to extend the same courtesy.

          2. The Other Kate*

            This is where I’m landing. If he doesn’t think chiropractic services should be used, then don’t offer a plan that covers them – mine doesn’t, so I know they are out there! But if it’s part of the plan, then you shouldn’t tell your employees which parts of the plan they can utilize. It’s no different than saying that the plan offers vision coverage, but it shouldn’t be utilized.

          1. Michaela*

            No. Biopsies are an important part of diagnosing many illnesses.

            Homeopathy, energy healing, reiki, chiropractic, crystal healing, naturopathy, psychic healing etc., however, shouldn’t be covered by insurance.

            1. anon for this*

              It’s really not up to you to decide what should or should not be covered by health insurance. That’s going down a dangerous path.

              1. JM60*

                Ultimately, someone is going to have to decide what is and isn’t covered by health insurance. And deciding on favor of covering evidence based treatments over quack treatments makes sense.

            2. Observer*

              So why are you claiming that chiropractic coverage is at the heart of the problem. The boss is trying to keep people from getting biopsied too!

            3. Yes We Can, Yes We Did*

              +1 to Michaela.

              And to anon for this, yes, if you’re the founder of a new company, or a CEO/head of HR/board member for an existing company, then yes, it is absolutely up to you to decide what should be covered by health insurance.

              Health insurance benefits are costly for companies. It is eminently reasonable for shareholders to insist that benefits cover treatments that have been subject to rigorous, peer-reviewed scientific studies. Yes, this excludes chiropractors (at least for anything other than spine issues) and certainly excludes psychic healing.

              And no, “but this is how I feeeeeeel about homeopathy” is not a sound argument. I am not willing to subsidize quack treatments, and the scientific method provides a basis for determining what constitutes a quack treatment.

            4. Countess Boochie Flagrante*

              Nice missing my point. That the boss is pushing back on both biopsies and chiropractic treatment means that most likely he’s not looking at the effectiveness of any treatment or diagnostic tool.

              1. Hera Syndulla*

                This!
                The guy doesn’t want it that you use the insurance, almost in a “no matter what” kind-a way.

              2. Observer*

                You are totally missing the point here. There is no reason to believe that he’s actually worried about the health of his staff. He’s not saying “be smart health consumers and avoid chiropractic for anything but spine issues” which would be a totally defensible statement. He’s saying “All chiropractic, and biopsies are a waste of money.” That is NOT a defensible statement, nor is it likely to have been motivated by any shred of concern for staff.

                1. Princess Consuela Banana Hammock*

                  Wait, are you critiquing Michaela or the Countess? (Because it sounds like the Countess is saying the same thing you’re saying.)

        5. Is It Performance Art*

          Depending on the state, insurers may be required to cover chiropractors. They will often require the insurer to cover a certain number of visits for specific conditions. There’s been a trend for states to require insurance to cover alternative providers. I think they’re not required to cover things that are far out of the community standard like IV infusion of cumin. If they’re in one of those states it may not be possible to offer a chiropractor-free plan.

          1. Observer*

            By your description, though, those requirements are quite narrow, and not just any alternative.

      3. Leave it to Beaver*

        “I’m personally not sure chiropractic should be covered by insurance, because he’s not incorrect that the evidence for its effectiveness tends to be anecdotal rather than clinical and rigorous – but that’s completely beside the point.”

        backhand compliment.

      4. Annon for this*

        It seems like the insurance broker or agent bent the owners ear about how the less you use insurance the less it will cost you for your renewal.

        When I complain about the 20+% increase annually I get similar talks from mine. How I should put young healthy people on the plan to keep the cost down, etc.
        The whole health insurance (many insurances) thing burns me up…and I will leave it at that.

        Educated guess says the boss just took a look at the line item for health insurance or it just came up for renewal. He is trying to “curb” the costs, based on insurance salesman’s ridiculousness. He needs to stop.

        2. the gold digger*

          Not to mention that in a very small group, the group’s claims are really not taken into account for premium increases. Or at least they weren’t when I was in the health insurance business. We didn’t start considering a company’s claims until that company had at least 250 covered employees and even with that, it was a mix of the company’s own claims and industry-wide claims.

          1. MikeN*

            Agreed. When I worked in health insurance, we had two kinds of pricing: experience-rated and community-rated. Very small groups (companies) were priced according to community ratings…essentially the claims experience of the larger overall geographic community. This is because very small groups just don’t have enough data to price accurately. So if you’re in a small company, your specific claims don’t have anything to do with your premiums. And if you’re in a big company which is priced according to actual claims experience, it would be very hard for an individual employee to move the needle very much.

            As well, this employer needs to get his nose out of employees’ health insurance claims…his attitude is despicable. Morality aside, I think he would have major legal exposure if he discouraged his employees from using their health insurance, and then one of them developed an illness that could have been caught by early diagnostic tests.

            1. Not So NewReader*

              This right here is very important for OP to see. The owner needs to understand how his premium is calculated, what is the basis. How ironic that it could be community-rated and have nothing to do with employee usage.
              OP, you can tell the boss to call and ask if he is community-rated or experience-rated. This might be a magic bullet that ends all discussion.

    5. Mike C.*

      There’s a massive difference between the folks who do physical therapy/massage and the folks that twists spines to “cure” various illnesses.

      1. Seriously?*

        Yep. I have used a chiropractor in the past because my spine literally was out of alignment (as evidenced by x-rays) but that is really all I would use one for. I would still be pissed if my boss told me I couldn’t use my insurance to see one if I wanted to.

        1. Snark*

          Yeah – the clinical and observational evidence is stronger for its use as a treatment for musculoskeletal issues, but very weak for the other maladies your less ethical chiropractors claim they can treat.

          1. Polaris*

            Yes – I started seeing a chiropractor because my spine was also out of alignment (one leg was shorter than the other because of the compression!) and continue to see them because the spinal problems are chronic. They don’t try to sell me on any other things chiropractics can “heal,” and I get some relief from my back pain.

          3. TheCupcakeCounter*

            yup – I told my chiro she was full of shit when she told me she could “cure” my chronic ear infections and allergies. She laughed and and told me the basis why it works for *some* people. I rolled my eyes and told her to put my tailbone back where it belongs so I can walk properly. If there is spine/joint or muscle issues I let her give it a try and have had some great results. My chiro also has massage therapists, physical therapists, OTs, on staff for a full service type of place. She’ll put the spice back in line then you go to the PT to get exercises to help strengthen the weak areas so you don’t have to come back as often. I was diagnosed with plantar fasciitis a few years back and the podiatrist gave me a shot and told me to come back when it hurt again. I was pretty pissed. It was my chiro who actually did something and gave me the exercises and stretches and some (very odd) adjustments that helped. Had no issues for a few years until last summer. Podiatrist didn’t do anything, chiro visits didn’t help this time so she suggested a treatment called IASTM (instrument assisted soft tissue manipulation) and it has worked better than I could have anticipated. I jokingly refer to it as the world’s most painful foot massage with a shrimp deveiner. My insurance doesn’t cover either but it helps me enough that it is worth paying out of pocket. Would love it if insurance covered it though. Seems for functional to me than muscle relaxers and pain meds.

            1. Snark*

              I had a touch of plantar fasciitis one time when I was in Thailand for a month, and got a foot massage at a place a Thai friend recommended me. I was dubious. I then had 90 minutes of whimpering in pain as a small, elderly woman dispassionately did her best to ram her thumbs – which had the strength of a hydraulic press – through the top of my foot. Next day? Pain disappeared. Lasted 10 years.

              1. Specialk9*

                Thai massage is amazing. It’s that good kind of hurt of a good massage hitting that spot, combined with them stretching you for you.

        2. Falling Diphthong*

          Anecdatum, musculo-skeletal: My daughter was impressed with the chiropractor called in for specific horse ailments at the barn she worked at. I’m quite sure that if you tell a horse “I’m going to press along your back, and at the fourth or fifth spot you should suddenly relax” the horse isn’t influenced by the suggestion.

          More broadly, though, I’m with Snark: If the company’s health insurance covers chiropractice, biopsies, and crystallography, then it’s none of CEO’s business which of his employees utilize any of those.

          1. Not So NewReader*

            Similar for my dog. He could barely stand up and walk around one day. He was only 5 years old. A vet-chiro came to the house. Inside of an hour we were telling the dog, “No-no, Buddy, don’t bounce around so much, easy, Buddy.” That was four years ago. He’s still fine. When things start to go out of line, he makes a particular gesture and we know. A little massage and he’s all set. One visit and he caught on to what the vet was doing.

      2. Lindsay J*

        Yeah, my dad went to a chiropractor for his back problems when I was a kid, and he felt like it helped with his pain. So that’s what I thought that they were – just practitioners that did a type of massage and physical therapy to help with back pain.

        I was really confused when one of my bosses started talking about the chiropractor she saw helping her with her immune system (which didn’t have anything wrong with it to begin with) and other such stuff that is not going to be cured by manipulating your back.

      3. Observer*

        That’s completely true. And it’s a real problem when chiropractors (or their boosters) try to sell if for things where it’s just not relevant.

        But, let’s be real – boss doesn’t know and does not care about all of that. Because anyone who is trying to convince people that doing a biopsy is a “waste of money” is not someone who cares at ALL about what makes medical sense.

    6. Leave it to Beaver*

      Well this comment spun out. It’s interesting that so many felt it important to stress their belief that chiropractic is not a valid form of treatment, while espousing that people should be able to use it. The contradiction is basically the essence of this entire letter. I said I love chiropractors and wasn’t a fan of the boss. Yet, many of you felt it necessary to detail to me (and others) that the treatment has its flaws and in so doing you are demonstrating the very reason why the boss man feels he has the ability or right to determine how others use their healthcare.

      1. Noah*

        Not at all. The point is that, within the guidelines of whatever health insurance you have, you should be free to seek out whatever treatment you want, EVEN IF I think it’s quackery. No reasonable, fair-minded person (other than the people at the insurance company specifically tasked with this job) would say, “I don’t agree with your course of treatment, so don’t do it.”

        1. Leave it to Beaver*

          I hear your point. But mine is that by stating your (figurative you, here) negative opinion to chiropractic in conjunction with your support, you diminish the effectiveness of your support and actually demean the person you’re supporting. And in the end you strengthen the argument of those who oppose it.

          And in this letter we obviously have a boss who is not fair minded.

          1. Noah*

            Oh, totally! I wouldn’t say, “I think chiropractors are phonies” to this boss. That would totally embolden him.

        2. JM60*

          To me, the what people do with the insurance you pay them is like what they do with the money you pay them. They’re both part of the employee’s compensation, and are the employee’s to do with as they wish. If the insurance you give them covers blood letting, you can simultaneously (correctly) think that blood letting is quackery, while also recognizing that it’s their right to use what’s covered under the plan as they wish.

      2. Snark*

        I think you’re either misunderstanding or misrepresenting the distinction many of us were making, which is too bad.

        1. Leave it to Beaver*

          I’m not misunderstanding. I would just ask why there were so many people who felt it necessary to discuss the potential illegitmacy of chiropractors… particularly if the legitmacy of chiropractors wasn’t the point of the issue.

          Saying that it shouldn’t matter whether chiropractic is legitimate means that it should be unnecessary to discuss whether it is or not, particularly as there are those (including myself) who feel that it is.

          1. Former Employee*

            Actually it does the opposite – it reinforces the argument. It’s somewhat like a person emphasizing how much they support the 1st Amendment by saying they are adamantly opposed to the ideology of a particular group, but their belief in the freedom of speech means they have to defend that group’s right to speak their horrible ideas.

          2. Snark*

            No; it reinforces and refocuses the point that it’s not what he’s meddling in that’s the problem, it’s the fact that he is meddling at all that is the problem, and that it is inappropriate whatever you think about the particulars. It reinforces the boundary I’m attempting to draw.

          3. Kathleen_A*

            Well, probably partly – but only partly – because you came out pretty strongly in favor of chiropractors, Leave it to Beaver. If the efficacy of the treatment isn’t important – and it isn’t in this case, at least IMO – then your going out of your way to support its efficacy right out of the gate as the very first comment is just as unnecessary as it is for those who do not approve of it to point out their belief in its ineffectuality.

            But the other reason is that this is something that many people feel very strongly about. It’s very difficult to say “I support your right to do X” and leave it at that when one is a strong supporter or opponent of X.

            That said, I’m pretty sure that if you hadn’t come out in support so early on, somebody else would have been equally assertive about their opinion, either pro or con, very early, too. It’s just that kind of topic, and this is that kind of commentariat.

          4. Leave it to Beaver*

            Ahhhh well… we’ll just have to agree to disagree. Y’all think I’m in denial, in danger, or psychosomatic, but support my right to be so. Much obliged.

            1. LouiseM*

              Don’t take this personally, Leave it to Beaver. If you’re new, this sort of topic is always a reliable source of drama and hundreds of comments on this site.

    8. Fiennes*

      I’m never going to a chiropractor for kidney trouble or migraines or any of the other more outlandish stuff they claim it helps. I have, however, gone for joint issues, with very good results. It’s hardly witch doctoring to see that some kinds of stretches/pops can to useful in those circumstances.

      1. Optimistic Prime*

        Not jumping into the above debate,* but I have seen a chiropractor before for migraine and it has helped me personally. I think that’s primarily because my migraines are associated with a stiff neck and shoulders and back pain, and relieving one often helps relieve the other in my personal case – I get similar results from massage, and some of the manipulation techniques that my chiropractor has used are essentially massage therapies. It also could be placebo effect potentially, but if it makes me pain-free then I don’t care.

        *I’m a public health scientist and capable of evaluating the scientific evidence on my own.

    9. Minnie*

      I love my chiropractor because she managed to get me to walk upright again. Now I’m pain free. Not every chiropractor is created equally, but to dismiss the practice all together makes no sense to me.

  2. Countess Boochie Flagrante*

    It’s also worth pointing out that it’s shortsighted as hell. Sticking your head in the sand and ignoring a medical issue won’t make it go away, but it could very well make it much more expensive to treat, a year or two down the line.

    Did he think that avoiding a biopsy would serve to ensure that it wasn’t cancer?

    1. Detective Amy Santiago*

      Right???

      What is the point in paying for healthcare if you’re not going to use it?

    2. Hey Karma, Over here.*

      It’s a scam, I tell ya! Those doctors, they just want your money!
      LW’s boss sounds like a crack pot. He may have some valid points about being proactive in your health care, but he took a left turn at Albuquerque and is in crazy land.
      Honestly, your best bet is to find him a new windmill. Maybe have him focus on pens and paper, or coffee cups. I’m only half joking here. If he can focus on some other ridiculous way to save money (that doesn’t threaten the health, much less the morale of the staff) maybe he will let this one go.

      1. Snark*

        Having lived in New Mexico, I can attest that if you turn left at Albuquerque, you will probably be in crazy land – wherever direction you’re starting from. It’s a strange and wondrous state.

        2. Bryce*

          Taking a left turn at Albuquerque, and another at Santa Fe, ends up at my hometown. So I can confirm.

        3. Kathleen_A*

          I am compelled to point out that doctors do indeed sometimes recommend a biopsy that isn’t medically necessary – not because they’re evil or greedy or anything, because most are not (I am a strong believer in preventive healthcare), but just because ours (in the U.S.) is a very testing-oriented health care system. Tests that aren’t medically necessary are prescribed quite often.

          The question, which we can’t answer, is: Did he turn down the biopsy because he’s a short-sighted idiot who is obsessed with saving money? Or did he turn down the biopsy because it wasn’t really necessary?

          We don’t know, and I don’t think the OP knows either. Only this guy and his doctors know for sure.

          Anyway, some of what was reported here by the OP is clearly ridiculous. But his turning down a biopsy isn’t proof of that unless we know why he did. And we do not.

          1. Totally Minnie*

            Here’s the thing. I have had a doctor tell me “it’s probably not cancerous, but I’d like to test it anyway just to be certain.” We did the biopsy right then and there in her office.

            I may be a little more sensitive here as a cancer survivor, but until someone invents a less invasive method of finding out whether or not a mass is cancerous, I will have the biopsy if the doctor tells me it’s a good idea. I would rather not make my medical decisions based on “probably.”

            1. Optimistic Prime*

              Right…and most of us are not really equipped to decide on the spot whether a test is medically necessary or not. In fact, the whole point of a biopsy is to confirm something that we’re not 100% sure about.

            2. Kathleen_A*

              All I’m saying is that there are *times* when a patient would be fully justified in deciding not to do a biopsy (or any of a number of medical tests). There are *other times* when a patient would be foolish to refuse the test. And there are *lots* of other times when a decent case could be made either way.

              If a doctor said what he/she said to you, Totally Minnie, I would absolutely do the biopsy. But we don’t know what this particular doctor said, and we don’t know anything about the circumstances. So I just do not believe we have enough information to say, “This manager was wrong and foolish for refusing this biopsy.”

              It’s fun and satisfying to say “What an idiot,” and it might even be true. But let’s be even-handed and logical. We ought not say, on the one hand, “How dare this guy tell people they shouldn’t go to a chiropractor! People have a right to make decisions about their own healthcare,” while also saying “He must have a biopsy every time anybody with “M.D.” after their name even hints that it might not be a bad idea.” If people have a right to make a decision about their own healthcare, they have a right to make a decision about their own healthcare. Many people who have just as strong an opinion about chiropractors as they do about biopsies.

      3. PersephoneUnderground*

        Lol- quote from Downtown Abbey (paraphrasing here) “..but what do we do? She’s such a martyr.” “So we must find her a more tempting scaffold.”

    3. Kaaaaren*

      100% this. He’s being ridiculous on a number of levels, but especially on the level that saving money now by pressuring people not to get things like scans and biopsies will potentially only lead to even greater medical costs if whatever the medical condition is goes undiagnosed/untreated for months and years.

      Also, I can’t help but feel like he’s being pretty “ageist” as well… So what if most employees are young and most young people are healthy? SOME young people certainly aren’t healthy and the presumption that they are/must be is potentially dangerous and harmful… I mean, I know someone who was diagnosed with a brain tumor at 28. Imagine if her boss had pressured her into not getting the CAT scan in order to save her company money based on the assumption that her age guarantees it’s probably nothing serious? (I know ageism is typically used to describe actions/feelings against older people, but I personally see lots of age-related nonsense directed as younger employees, too, and I think this qualifies.)

      1. Snark*

        Right? So when that mole turns into full-blown skin cancer, is that going to be good for his contribution to the group plan?

        1. Kaaaaren*

          I have a strong suspicion this boss would get on the employee for not looking into it sooner… Either that, or he’d recommend a series of kale-based creams…

      2. The Original K.*

        Yeah, young people can have any number of health issues. The average age of MS diagnosis is mid-30s. Not to mention slip and falls, car accidents, mental health issues (schizophrenia symptoms often pop up between 16 and 25 for men, slightly later for women). The boss’s assertion is simply ridiculous.

        1. MsChanandlerBong*

          I’m 36. I was born with spina bifida, which caused me to develop chronic kidney failure when I was 3. At age 6, I developed high blood pressure as a complication of the kidney failure. By the time I was 12, I had had eight major surgeries, including four on my spine (four laminectomies to repair a tethered spinal cord), plus a bunch of minor ones (tonsils, tubes in my ears twice, adenoids removed twice because they grew back the first time). At 26, I was diagnosed with lupus, and at 31, I was diagnosed with heart disease and underwent an angioplasty with stent placement. In addition to all of this nonsense, I occasionally have random medical conditions pop up and then disappear as quickly as they came–a cyst in my brain, granuloma annulare around my ankles, etc. I hate it when people assume that because I am young, I couldn’t possibly have so many issues.

              1. JeanB in NC*

                Was there? I didn’t intend anything other than to say that my problems seem small in comparison.

              2. Jennifer Thneed*

                If you’re going to critique someone’s word choice, it would be super-helpful to suggest an alternative. Otherwise you doom that person to trying again, and possibly getting it wrong again, and getting told off again.

                1. MerciMe*

                  Or, just don’t call out differences about things people can’t change, in a way that puts you one-up by contrast. There’s never an unambiguously polite way to do that (about the best I can come up with is “I sympathize, that sounds very difficult”).

                  But since the thread op said they were okay with it, I would have been willing to let it rest there.

          2. DrWombat*

            Yep. My cousin was born with spinal issues and uses a cane. They still get taxi drivers refusing to give them rides, or people refusing to give up seats on transit/insisting on their seat because “you look too young to need a cane/be disabled” and has been accused of faking multiple times (even by family who have known them since birth!). Congenital issues exist, and accidents can happen at any time. *offers you Jedi hugs*

          3. Michaela Westen*

            Thank you! I feel much better about my health problems now. ;)
            I also had health issues since babyhood – a lot of allergies, messed up stomach – which were never managed growing up and which I had to learn to manage as an adult.
            When I was young I was sick all the time and the expectation and pressure that all young people are strong and healthy made me pretend to be healthier than I was, and made me feel like loser.

          4. Spina Bifida Here Too*

            Yeah-spina bifida here too- as well as cloacal exstrophy which has made life extra fun. (Actually it is more likely the spina bifida is a result of the spinal problems often accompanying extrophy.) By the time I was 12 I had had at last 12 major surgeries. My lesion is fairly low on my spine so I can walk unaided which makes it an “invisible” disability which nonetheless costs a lot of money every month to even function normally. For a decade I had to pay for all of it out of pocket because even when I could get insurance it didn’t cover pre-existing conditions. I have to have my kidneys monitored closely because there is a high likelihood of kidney problems with my medical history. I am highly prone to UTIs and I have an ostomy.

            I actually am in fairly good overall health, but my baseline necessary medical care is higher than a “normal” person’s because of factors completely out of my control.

          5. SB here too*

            I got SB as well (and I just turned 30, so yeah, health insurance is a must). Thankfully I’ve only had 3 surgeries so far. One to untether my spinal cord (6 months old, so I don’t recall it), one to stop a reflux towards my kidneys (kidney function is lower because of the reflux I had, yet not alarmingly low atm. It does get checked on a regular base at my hospital) and one to correct my clubbed foot (if left untreated I would have ended up in a wheelchair by now).
            Because I can walk (just don’t let me walk (let alone “run”) a 3K or something, anything longer than 1K and I use a cane) it is a “hidden handicap”, which gives a lot of frustrations because not every person believes me when I say I can’t do certain things. Because of good health care where I live (not USA), I get a lot of financial support (catheters, medicine to prevent/limit the effects of UTI’s, insoles, etc.).

            So far, it is all going well. Can’t complain much and I know that with only 3 surgeries so far *knock on wood* I am definitely one of the lucky ones with my condition. But without yes, baseline medical care is higher here as well. Thank God for decent insurance.

        2. Anonish*

          A high school friend of mine with three young children was just diagnosed with breast cancer at age 31. Serious illness has no age limit. It makes me so angry to think what would have happened if she worked for a boss who discouraged her from getting a lump checked out because she’s “too young for breast cancer”!

          1. Detective Amy Santiago*

            Yup, I have a friend who went through breast cancer treatment in her late 20s.

            1. Triumphant Fox*

              YES. A friend was 23 – double mastectomy, two rounds of chemo, the whole thing. She’s in recovery now, but if she hadn’t been aggressive in seeking treatment, she would not be here.

          2. Strawmeatloaf*

            Heck if that were true, then children wouldn’t get cancer and other serious conditions/diseases.

        3. Environmental Compliance*

          I developed pretty severe cubital tunnel in both elbows. I couldn’t use my right hand – I couldn’t feel any sensation other than pain and tingling. I had the zappy zap test done and it showed a near halt of any nerve signal past my elbow on my right arm, and about 50% on my left.

          But I was only 21, the surgeon said, I need to stop being so dramatic and just *deal with it*. There’s *no way* a 21 year old could have this.

          A separate neurosurgeon performed surgery on my elbow and I now have most of the sensation & movement back. My grip strength will never be the same because of how damaged the nerves ended up being since the surgery was postponed for so long. I still can’t feel my pinky on that hand very well. My ring & pinky fingers are twitchy on bad days. Writing is a pain. But hey, 21 year olds don’t get cubital tunnel!

          2. J-squared*

            I had carpal tunnel and cubital tunnel in both wrists/elbows by age 23. I got a couple docs who wouldn’t believe me, but once I had the “zappy zap test” done (I love that very accurate name, by the way), they stopped being such obstinate butts. (I also moved over to rheumatologists, because of all over joint/inflammation issues that are permanent and ongoing, and they are the best at believing people, in my experience.) Sorry you had such a terrible experience!

            1. Stinky Socks*

              The worst thing about the zappy-zap test, is that if the neuro doesn’t quite believe you could have *that* flat of a nerve response, she will repeat it. Repeatedly. On the same spot. Just to verify that yes, you have a raging case of carpal tunnel.

      3. Code Monkey, the SQL*

        The ageism is an excellent point. Discouraging younger employees from using their insurance because it’s “probably nothing” would be sketchy sketchy sketchy if you switched the group in question out for another one.

        Not to mention the people, especially women, that I know who went to the doctor for “probably nothings” that turned out to be, in the order I remember, ovarian cancer, Non-Hodgkins lymphoma, and non-epileptic absent seizures.

        Being under 30 is no guarantee of health.

        1. RVA Cat*

          This. Plus I imagine he’s a real peach whenever an employee dares to get pregnant….

          Oh and will he also ask some super-fit tech bro not to get X-rays after he wipes out mountain biking?

        2. Kaaaaren*

          Absolutely. If it were directed to any other group besides “young employees” it’d be so clearly wrong and ridiculous, it wouldn’t even be a question.

      5. arjumand*

        Absolutely! Also, I’m especially side-eyeing this bit of wisdom:

        “how to stay healthy and exercise (and how this benefits the company).”

        Maybe I’m prejudiced, having been diagnosed with an immune disorder last September, but not everything comes from lack of exercise – some illnesses are just there (when the first word in its name is “idiopathic”, that’s the doctors’ way of saying ‘we have no idea where this came from’), and they have to be treated, somehow.
        If I worked there, I’d resent the implication that my illness is somehow my fault, when it’s something beyond anyone’s control.
        Though someone who decided not to do a biopsy (?!?!) is just a moron, IMO.

        2. Junior Dev*

          My most expensive healthcare expenses, by far, have come from injuries I got while running.

        3. Julia*

          I’m still furious at people and websites that suggest endometriosis goes away through yoga and cutting out meat. I’ve been a vegetarian for years and my endo only got worse, and the thought of moving while in that much pain almost made me vomit.

          Of course my last boss also thought that young people had to be the picture of health, to the point where older people could take their aggressions out on me. (As in, “he can’t help yelling at you, he’s old! Oh, you’re feeling stressed? Go and have a drink.”)

      6. Falling Diphthong*

        I did not expect the first person to manage to max out their individual contribution to be one of my athletic children. Then kablooie went an ACL.

        1. SarcasticFringehead*

          Yeah, I went roller skating with some friends for exercise, and the resulting broken arm cost my insurance $70k.

          1. Slow Gin Lizz*

            $70k for a BROKEN ARM????? That’s insane. (But we’re not going to get into the insanity of health care costs in what I assume is the US.)

            1. Mandatory Fun*

              It kind of depends on where and how the fracture is–some fractures involve surgery with implants (metal plates, for example), followed by extensive physical therapy.

      7. Indie*

        If you’re a woman there’s plenty of regular checks and things to be screened for *because* you’re young.

      8. wanda*

        My best friend was 24, working for a tech startup and in very good health when he starting feeling persistent pain in his knee. His doctors referred him to physical therapy but the pain only worsened. After months, his mother, a retired doctor, stepped in and said that that kind of pain was abnormal for someone his age and health level and forced him to have a CAT scan. Lo and behold- it turned out to be a very rare type of cancer.
        Chemo and doctors that specialize in super-rare cancers are expensive, and I’m sure that his cancer raised the startup’s premiums. But, no one complained, and they were supportive throughout his chemo. As they should be.
        Doctors have a saying- when you hear hoofbeats, think horses, not zebras. But zebras exist, and sometimes they roll in the mud so no one can see the stripes. That’s why it’s important to go to medical professionals when sometimes is persistently or severely wrong, even if it turns out that your ailment was just a regular horse. And certainly, the startup CEO is the wrong person to try to be making these distinctions.

        1. Random Obsessions*

          “But zebras exist, and sometimes they roll in the mud so no one can see the stripes.”
          This is brilliant and I am stealing it.

      9. Hey Karma, Over here.*

        When my nephew was in medical school I asked him about working in the hospital. He introduced me to a med school aphorism (I think that term fits): “poor people get sick.”
        What?
        He explained, not to be flip or cold, but to be honest…that people with better jobs have better health care and can get preventative check ups and early treatment. Annual checkups, blood work, biopsies get done before there’s a health crisis.
        Because, apparently they don’t all work for myopic loons.

      10. many bells down*

        A friend of mine just died from a sudden, aggressive cancer at 32. She thought she had the flu, went to the doctor, and 4 weeks later she was gone.

        And I was born with a heart defect, so I’ve never been “too young” for medical problems. I had open-heart surgery before my second birthday.

    4. k.k*

      That’s a great point and one that might actually make the boss rethink things. He’s clearly all about the bottom line. It might be worth pointing out that if everyone gets preventative care and early detection, that could still be much cheaper than one or two employees needing long term serious care.

      1. Countess Boochie Flagrante*

        Yep. This really doesn’t sound like a guy who’s going to have any interest in the ethical argument, so pointing out the prevention/cure exchange rate might have some hope of getting through his skull.

      2. Rusty Shackelford*

        Actually, I think it would be great to write about preventative care and early detection and which check-ups and labs should be done on an annual basis to give you the best shot at being healthy. Because that’s his bottom line, isn’t it? His employees being healthy? (rolls eyes)

    5. fposte*

      I mean, there are definitely questions worth raising by qualified experts about whether a biopsies or other diagnostic tools are overused in some situations. But “Dude Who Owns a Startup” isn’t a qualified expert.

      1. Countess Boochie Flagrante*

        Yep, there’s a huge difference between “is this specific procedure called for in this specific situation” vs “stop using preventative health care you guys, it costs money!!!”

      2. Alton*

        Right, and in my experience, insurance companies already require justification and will push back on things that don’t sound medically necessary or that don’t follow standard diagnostic procedures. I don’t always trust insurance companies to make those calls, but they’re probably more knowledgeable than this start-up guy is.

        1. Princess Consuela Banana Hammock*

          Exactly. This guy is just being intrusive and deeply problematic. If the insurer thinks the biopsy is overused/unnecessary, they’re going to avoid covering it (because like the Boss, they don’t like spending money, either). Not that that outcome is fair/right/medically sound, but there’s enough discouragement built into the system that OP doesn’t really need more from this dude who has to pay for benefits but doesn’t want to actually have to pay for benefits.

    6. Seriously?*

      Yep. There is a reason that a lot of insurance companies encourage regular preventative care. It is much cheaper to catch a problem early than late.

    7. AnonEMoose*

      When there was something they weren’t sure of on a mammogram, with my family history, you can damn well bet that I accepted the option of a biopsy when offered (the other option was to wait 6 months and check again). It turned out to be nothing, but I know that a lot can happen in 6 months…plus I knew that I would not handle the waiting very well. Best to know, at least for me. Someone else may have felt differently, but it should still be MY decision when it’s my body. (Of course, in my case, the cost of biopsy now vs recheck in 6 months might have been about the same, but that’s not really the point.)

      1. King Friday XIII*

        Having done the biopsy due to family history and had it turn out NOT to be nothing, I guarantee you that it saved my health insurance money, and I think the idea is that overall we all balance out. ;P

        1. Slow Gin Lizz*

          Even if a biopsy DOES turn out to be nothing, the biopsy should still be performed so everyone knows there’s no issue. Negative test results are still results, right?

          1. AnonEMoose*

            Totally agree. And King Friday XIII, I’m so glad you had yours done. In my case, the peace of mind was totally worth it to me. And one advantage is, they put in a marker so that they know, on future scans, which spot was tested, and they can watch it just in case of any changes.

          2. fposte*

            That’s actually a statement under some review these days; biopsies aren’t cheap or non-traumatic, and we’ve had a lot of years of CYA medicine in the US that means things get done because facilities are afraid of getting sued if they’re not or because patients demand them, not because they correlate to a better outcome.

            We like the definitive in America, but we’ve been oversold as patients on how possible it is and whether it improves our health to get there.

            1. Slow Gin Lizz*

              Well, sure, that can happen. But I think we can both agree that a CEO of a non-medical organization probably isn’t the right person to decide who gets a biopsy and who doesn’t, right?

            2. Tau*

              There’s actually some interesting counter-intuitive statistics around this one, as well; these sorts of medical screening tests can have very high false positive rates, not because of anything wrong with the test but because of the population statistics involved. There’s definitely a point where it’s not worth it. But as you say, we like certainty and the feeling that we’re doing everything we can.

              1. fposte*

                Yeah, the mammography work especially is really fascinating; it’s going to be nearly impossible to break that “early detection” mantra, despite the fact that early detection doesn’t actually seem to lower mortality.

                (And yet I still get mammograms.)

      2. The Original K.*

        I had a lump the size of a golf ball removed from one breast when I was in college and a biopsy on the other breast when I was 26. (I’m fine, both lumps were benign.) My aunt died of breast cancer at 34, so if my doctor says “I’d like to take a closer look at this,” I damn well listen.

        1. Detective Amy Santiago*

          I know a couple of women who tested positive for the BRCA gene and had preventative mastectomies.

        2. AnonEMoose*

          One of my aunts died from breast cancer at age 43. Another one had a double mastectomy. So, yeah, if the doc says “we want to look at this,” I’m going to listen.

          1. Ugh.*

            My mom was diagnosed with breast cancer at 45 (she’s fine now at 60). One of her sisters and one of her cousins also had it in their 40s and 50s (both are also fine). They’ve all tested negative for BRCA but given that screening and early detection is the entire reason all three of them are alive…yeah, if a doctor thinks I should get something checked out, I’m getting it checked out.

    8. Slow Gin Lizz*

      This is just a terrible attitude to have about health, period. I have been lucky that my last two jobs have always been great about just taking time off for illness or if you have a medical issue and need to see a doctor. It sounds like not only is this CEO trying to save money by not paying for insurance, etc., he’s also trying to keep his employees from taking the time they need to get healthy if they need it. I’d run far, far away from this company and this guy, personally.

      1. Not So NewReader*

        The sad fact is that bills go up no matter what you do. As a parallel, when I first moved in here, oil was 90 cents a gallon. I got a computerized thermostat to help me save money. Oil still went up in spite of me trying to save money. A few years ago we were paying over $4 per gallon for oil. Right now I am paying a little more than 2.5 times what I paid when I moved in.
        Bills go up and that is reality. This guy scares me in that he lives in a dream world where he can prevent bills from going up. That is not how life works, Boss. His thinking should be to figure out how he will pay the insurance bill WHEN the bill goes up. It almost appears like he has no other plan but to just prevent the employees from using their insurance.
        How many times have we talked about companies that won’t let a person use their PTO or whatever. If people are not allowed to use a benefit that is the same has having no benefit. He will lose people by not allowing them to use their insurance.

    9. Jadelyn*

      Right? Like…that is an enormous contributing factor to the US’s notoriously overburdened and awful healthcare system! People don’t have resources to seek treatment until it’s an emergency, at which point its 10x as expensive to treat or manage. He’s literally encouraging that kind of behavior which is going to be counterproductive anyway.

    10. Kathleen_A*

      I can’t make up my mind about the OP’s boss. Some of what he seems to be suggesting sounds extremely ill-advised or possibly even stupid – but not all.

      In the ill-advised/stupid category, I agree that he’s definitely intruding in an area in which he does not belong when he starts proscribing a medical treatment that is covered by insurance. Whether he loves or loathes chiropracty, that’s not his call, and he should cut it out.

      In the “not such a bad idea” category, there is inherently nothing wrong (so long as it’s done factually and with the patients’ welfare in mind), and possibly even a lot right, in assembling information that gives employees some pointers to help them decide when they should and when they should not seek out medical treatment, because that’s something that a lot of people (including people who are fairly new to adulthood) are confused about. I can remember being given a book on when a doctor’s visit was necessary not long after I got my first professional job and was learning about insurance coverage. It was *really* good. I think I still have it around somewhere.

      And in the “too close to call category,” the medical profession does indeed sometimes suggest a biopsy when it’s not medically necessary. The question is, did he decide not do have the biopsy to save money or because wasn’t truly necessary? I don’t think any of us can answer that, including the OP.

  3. JokeyJules*

    I would liken this to when you’re given PTO, but very strongly discouraged to use it.
    Except, this is your health. I believe in workplace “healthy-living” programs, but this isn’t okay.
    If the CEO is seeing financial issues in other places and trying to make up the money by cutting costs in healthcare for this employees, that’s awful and a bad sign. It’s a bit of a reach, but I think a possibility.

    1. Observer*

      Good point. As a cost cutting measure, this only makes sense if you are looking at the very, very short term.

            1. Detective Amy Santiago*

              That’s like the equivalent of the “join my MLM downline and you’ll make so much money”

          2. Long Time Reader, First Time Poster*

            If I only had a nickel for every startup stock option I ever held…

            1. Autumnheart*

              I worked for a start-up that was supposed to go public the week the market crashed in April 2000. That was the only one where I even came within shouting distance of getting stock options. Of course, then you have to wait for them to vest. I knew more than one person who was a millionaire on paper for a while, but whose paper millions came to naught because the company went bankrupt before they could cash out.

    2. Lara*

      Eh, I think PTO should be *part* of any workplace healthy living program. There’s no point in giving Jane free fruit if Jane’s teeth all fell out because you won’t let her go to the dentist.

      1. JokeyJules*

        where I was going with the healthy living program is just that that is the only involvement I want from my employer in my personal health decisions.

    3. overcaffeinatedandqueer*

      Even things that cost more initially, like insurance reductions for gym attendance, save in the long run. If one wants to really save health insurance money in the long term, spend now to foster a culture of and support healthy food choices and employees to exercise. Even healthy habits and small weight loss cause a measureable reduction in health care costs. I know that I cost less to insure now that I am healthier and only use one, not three, asthma medicines and no longer need treatment for acid reflux.

      1. Luna*

        +1. If LW thinks she can redirect boss’s focus to encouraging & supporting healthy behaviors, rather than shaming/discouraging behaviors the boss doesn’t like, I think that is the best strategy. Offer cost reductions for gym memberships & fitness equipment, allow employees to have flexible schedules so they have time to exercise, have healthy snacks around the office. Those will all save more money down the road than telling someone not to get a biopsy against their doctor’s advice!!

        1. Cordoba*

          “redirect boss’s focus to encouraging & supporting healthy behaviors”

          That opens the whole Pandora’s box on what people think healthy behaviors are. One person’s “commonsense encouragement” is another person’s “shaming”. Just check any comment thread on a topic dealing with health, nutrition, or exercise if you don’t believe me.

          1. Oxford Coma*

            There are effective ways to do it. My company subsidizes the cost of the salad bar and “healthy” food line in the cafeteria. The fried food/pizza/junk line is full price. I’m currently eating a giant salad with all kinds of nifty add-ins (unsalted sunflower seeds, purple carrots, yellow tomatoes) and it cost me $2.00.

              1. Detective Amy Santiago*

                Seriously!!! I would love to work somewhere that stocked a healthy salad bar and made it cheap for me.

                1. Countess Boochie Flagrante*

                  We have a delightful salad bar but I never seem to be able to walk away from it for less than $10. Considering how hard the “how many fresh veggies do I buy?” calculus is for a single person, I’d eat at a subsidized salad bar every workday without fail.

            2. Willow Sunstar*

              I am jealous of your salad bar. My company offers the same boring veggies M-F. Nothing new or trendy, ever.

          2. Luna*

            I don’t think offering employees the option of discounted exercise and health food benefits is “shaming.” Everyone is free to use (or not use) those benefits however they choose, but the point is to have them there.

            1. SarcasticFringehead*

              Sure – the issue is when employers start offering rewards for using those services or calling out people who don’t use them, which seems like a thing this boss would do.

      3. Detective Amy Santiago*

        One of the perks of my new job is discounted memberships to various health facilities. At the local Y, they will wave the join fee ($75) and you get a $10/month discount. Also, if you go at least 6 times a month for three months, the fourth month is free.

      4. Raining cranes*

        My old company in Europe offers a card that gives you unlimited access to almost all fitness/yoga/exercise classes/swimming/organized sports/whatever else you could think of in the city. The card is really cheap for the employee and the employer pays the rest. It was awesome, I could go to any class I wanted. I don’t think insurance was the motivating factor since the country I was in has mandatory state health insurance that is a percentage of your salary and is basically like a tax. The company also offered additional private health insurance which just covered more elective procedures and made going to the doctor a little easier. It doesn’t cover big expenses like cancer treatment for example. They also provided annual physical exams to all employees for free during the work day, they even provided transportation to the clinic. So pretty awesome.

  4. Snark*

    The correct response to his position is, “I will decide what health care I need under the insurance I pay premiums on, for whatever sagacious or frivolous reasons make sense to me, and you can piss right off with your finger-shaking, penny-pinching nonsense.”

    Pity you can’t say that.

    2. Naomi*

      Not in so many words, as satisfying as that might be. But I think OP could more diplomatically say, “People’s decisions about their medical care are personal and the company shouldn’t be interfering in private health issues.”

      Also, this might not have crossed a legal line yet, but I shudder to think what will happen down the line if an employee needs to negotiate an ADA accommodation with this boss.

      1. Indie*

        I’ve been waiting for someone to raise a legal angle. This can’t be legally safe behaviour, can it?

    3. Tree Octopus*

      Exactly! My healthcare is part of my compensation. Asking me not to use it is like asking me not to cash my paycheck.

  5. ExcelJedi*

    This gives me the creeps, and would make me wonder how much transparency he has into what insurance is used for. Like, would he think therapy was a worthwhile use of insurance? Birth control?

    Shudder.

    3. CityMouse*

      Alternately, would he scold an employee for getting pregnant because it is so expensive for insurance? Fortunately that could lead to someone pout ing yo a clear law.

      Now it is tough to say exactly where the line is, but if he complains about an ill or disabled employees medical costs and suggests some kind of retaliation for it, he could run afoul of some legal protections.

      2. Autumnheart*

        He’d probably do what other employers do, and suddenly find “performance issues” with his pregnant employees that magically result in them getting fired. If he even hires women at all.

        1. CMart*

          Or perhaps what my company did– add a rider (that you don’t have access to unless you ask the right people the right questions) that routine OB ultrasounds will not be covered by our otherwise good policy.

          Getting a surprise $500 bill for the “routine” anatomy scan that makes sure your fetus’ organs are developing properly is a great time. Certainly makes being pregnant while working here pleasant.

          1. Amy*

            That’s fun, my OB just told me I’ll be getting an ultrasound at every appointment going forward. Luckily my insurance covers it because that would be a hefty bill if they didn’t. It’s seems a weird thing to not cover, my husband’s ultrasounds for his thyroid cost way more than my OB ones. And how many pregnant people are there in an office each year getting ultrasounds.

    4. Natalie*

      No, he wouldn’t be able to look up an individual employee and see how they’ve used their insurance – HIPAA applies to the insurer so they have to keep that information private without the patient’s explicit permission.

      However, he could potentially be getting annual reports from his insurance company with aggregated detail about claims, and in a smaller company it can be obvious who the only childbirth claim was or similar.

      Companies who self-insure are required to follow specific rules to keep private health information protected, but those are almost always very large firms. I’d be shocked if a little startup was self insured.

      1. Raider*

        I don’t know. I worked for a small family-run diner which did offer health insurance to employees who had been there over a certain amount of time. And seemingly immediately after one particular employee became insured and filed a claim for an expensive antidepressant, literally everyone knew about it. I don’t know who first talked, but everyone knew, because the conversation was around both how expensive the meds were and how insurance costs would go up.

        1. Natalie*

          I can’t tell you what happened there, but if it was after HIPAA the least likely explanation is your health insurer revealing PHI to an employer. The fines aren’t small.

            1. Wehaf*

              No, but health insurance companies tend to be pretty well-acquainted with HIPAA, which was Natalie’s point.

      2. Judy (since 2010)*

        From comments I’ve heard at a past (self insured) company, my guess is:

        – Companies get statistics on how many of what type of procedures have been done.
        – Companies get the amount spent by each individual employee.

        I know the first is true, at least for large dollar procedures because they put it in their benefit brochure for the next year. I’m fairly sure the second is true. I’ve heard a manager talk about how much Wakeen’s open heart surgery or cancer treatment cost the company, using specific dollar amounts, such as $37,000.

          1. Jessie the First (or second)*

            HIPAA applies just as much to self-insured plans, though. Yes, it means there are very specific people in the company who do get health claim information, but if those people blab about it to literally anyone, the company is subject to the same fines the insurer would be subject to in a fully-insured plan.

        2. Former Insurance Acct Mngr*

          Having worked for an insurance company while holding an agents license, I agree with Natalie. The employers (sometimes they are smaller than expected) do receive quarterly reports analyzing where their funds are being spent. The intent is not to release personal information, but to help determine if there is an area where educating employees can be beneficial. i.e. Excessive ER visits for non-emergency treatment. Potential education on the importance of developing a relationship with a primary care physician is needed.

          Even though the reports are HIPAA protected, most employers (especially smaller ones) know their employees well enough to decipher who is spending the majority of their funds. The reports should not be broken down by employee in any manner, but can be broken down by department.

      3. Wings and Warts*

        Little start-ups are even more likely to have a high deductible health insurance plan coupled with an HSA. If the company funds that HSA and has rules about funding on a schedule (for example, quarterly), then you can run into disclosure issues if the company requires employees to submit medical bills in order to accelerate the HSA funding to cover a big bill. Sorry, that was long-winded, but as you might guess, I have experienced that with an employer. My employer asked for the medical details to be redacted on the bill for privacy reasons (HIPAA), but you can imagine that not all small companies are as astute.

    5. Raider*

      If I had just gone to a chiropractor and then he made these comments publicly, I’d definitely be paranoid that he’s tracking my insurance claims specifically and that I could lose my job if I continued, because he’s made clear he thinks these are frivolous sessions and are directly hurting the company via insurance costs.

      It will be interesting to see if he singles out some other use in the next public meeting. Because I have to think he actually is using real examples as basically threats.

    6. Geneva*

      You read my mind! I would HATE for my employer to know what meds I’m taking, especially if they don’t “believe” in them. Like birth control, of course, or let’s say anti-depressants. Could you imagine your boss telling you to just perk up instead? Nope. Health care is personal.

  6. Irene Adler*

    Boss comments make me wonder if he’s getting ready to reduce/cancel medical insurance coverage. Maybe even blame the employees for having to do so, citing that they drove up the costs too much by using their coverage.

    I work at what was once upon a time a start-up company. Back then there were times when the VC people would advise the president to cancel our medical insurance to save money. President refused.

    Today this company is hurting for $. So they cut back on health care coverage (among other benefits). They will only cover the employee. Coverage for spouse and family was terminated. Ouch!

    1. Jam Today*

      Remember when Tim Armstrong did that at AOL? He singled out the infants of two employees — very easy to identify, since people know their coworkers and know when they have babies — as the reason why the company was cheaping out on their 401(K). This is such a classic move by people in power, to get the powerless to turn on each other instead of questioning the competence and intentions of the people running the show.

      http://www.slate.com/articles/double_x/doublex/2014/02/tim_armstrong_blames_distressed_babies_for_aol_benefit_cuts_he_s_talking.html

        1. strawberries and raspberries*

          Wow, that’s monstrous, especially when you look at his gloaty-ass Instagram account with his entire family in it.

    2. Seriously?*

      Reducing coverage or increasing deductibles would actually be less icky. Then he can’t pretend that the company offers this great benefit while actively discouraging anyone from using it. People would see that the health insurance sucks and make employment decisions with that in mind.

    3. Submerged Tenths*

      But at least employees still have coverage! My employer is hurting for $$$ – we haven’t had a raise in years. But they still cover 100% of employee health insurance. I figure that’s actually been a raise, given the cost of insurance rising yearly.

  7. Detective Amy Santiago*

    Here’s hoping we can avoid the non-Americans from commenting about how terrible our healthcare system is.

    We know.

    1. Snark*

      Yeah, seconded – friends from places with sane health policy, we see you, we envy you, and we really don’t need any aghast “oh my god this is barbaric” comments on this. We do know, but it’s not going to be helpful, because it’s not changing anytime soon.

      1. SoCalHR*

        and please resist the urge to remind us how much vacation time you have as well (gets me every time)

    2. Lara*

      I won’t but I did want to ask – isn’t the quality / quantity of health coverage something you negotiate as part of employment? It seems like he’s trying to retroactively withdraw a negotiated part of his employees compensation / benefits package.

      1. Falling Diphthong*

        He’s trying to do it with pressure, rather than by changing the insurance package offered. You get people in the door by offering generous health insurance and generous PTO, then put on your sad mime face as you explain (through mime, and an invisible box in which the mime is beaten up with invisible clubs) that it makes the company sad when people decide to hurt the company by using those things.

        1. Lara*

          Oh yes. I’ve had that before with PTO. “You have x amount of days. Only we can’t spare you that specific day. Or then. No, not then either. Don’t you care about this company?”

      2. Bea*

        No. Quality of HC is always fluid and may be changed year to year.

        It can come down to using it in negotiating in terms of “you expect me to pay 20% of premiums, so pay me more…” You can go into a job thinking you had 100% covered by the company so you took 50k instead of asking for 55k. Only to have the turned to 80% or 0%.

        We don’t have contracts so negation is in good faith. Always remember that.

        I have never seen benefits listed in an offer letter.

        1. Natalie*

          I’ve always gotten a cut sheet on benefits with the offer letter. It may not be universal but it’s pretty common.

      3. Natalie*

        Not really – the employer is buying one or maybe several big plans that everyone who signs up is covered by. You generally can’t specifically request that a certain thing be covered, it’s either part of the plan or it isn’t.

        1. Lara*

          But presumably you know what is in the plan ahead of time? And say, would agree to the job if the HCP covered X but not if it only covered Y?

          1. Natalie*

            Yes, at least every place I’ve been offered a job has had a benefits sheet that includes health plan details, cost of premiums, whether they offer any tax sheltered health accounts, etc. And some companies do have multiple plans so you can pick, say, a plan with a smaller employee contribution if you don’t anticipate using much health care.

          2. NW Mossy*

            The answer is “sort of.” You can generally get deeply detailed statements of what the coverage is if you ask for it, but it’s not the default to provide this and many people don’t ask. That can make it tricky if you do ask, because it can trigger assumptions that you’re asking because you know you have a particular condition that’s expensive to treat. It’s also not all that helpful when it changes frequently, or when you develop a condition after being hired that wasn’t even on your radar when you were looking at the benefits package initially.

            2. Alton*

              It can also be trickier than you’d expect to find out exactly what a plan covers. Not all insurance companies are good at having that info easily available online, and sometimes it’s hard to guarantee that what you’re reading actually applies to your plan. Like, I found info on my insurance company’s website about transgender-related care that’s covered, but then I got a document from work about coverage exclusions that said that nothing related to being trans (even therapy!) was covered.

              1. a name*

                Same here. My husband’s insurance (state employee, Southern) flyer listed no reproductive health benefits except for pregnancy/birth. But if you dig through the website after enrolling, it covers the full complement of women’s sexual healthcare, including contraception, abortion, and sterilization.

          3. Detective Amy Santiago*

            Currently, there are minimum standards that health plans have to offer. These were set under the Affordable Care Act. So if that gets rolled back, those minimum standards go away.

          4. Liane*

            “But presumably you know what is in the plan ahead of time? And say, would agree to the job if the HCP covered X but not if it only covered Y?”

            Sort of. You know what is covered in the –Current Year’s– health plan. But that can change* every calendar year, and the earliest you will find out is usually October of the year before it takes effect. So it may cover X when you accept/start but not after the new year. Same if you’ve been working someplace for a few years and it’s always covered X; there’s no guarantee that it will be covered next year.

            *There are some things that Federal law/regulations require to be covered, and some states may require additional coverages, so those won’t change unless the relevant laws are changed

            1. Liane*

              PS to Lara. I think even if it’s a bit derailing, this was a valuable question. Much better than all the “How terrible for you poor deprived dears!” pearl-clutching comments. Those DO get old.

              1. Lara*

                I do apologise for the derail, but thank you and I do appreciate the clarification. I was seeing this very much as a change of compensation, along the lines of making hourly employees work free overtime, and wondered if it might fall under the same laws (so OP could push back).

          5. A Non E. Mouse*

            I’ve been at this job over a decade, we are on our third insurance company, and my cost for family coverage in that time has doubled.

            While each plan during that time has covered *basically* the same things, it takes me approximately a year to suss out the difference with each switch – mostly in required referral procedures, but also what local health networks are considered “in network”, and what doctors are considered “specialists” and subject to a $50 copay instead of a $25 copay.

            So the problem isn’t what insurance is in play when you accept the job – it’s what insurance you have *right now*, which can potentially change each year (or in one notable case, we had a local health system withdraw as in network mid-year, resulting in a lot of claims having to be handled onsey-twosey by employees, then insurance company and our insurance coordinator).

          6. Kj*

            Plans change. I got a job with good benefits, then the healthcare stuff was restructured and they became increasingly terrible. I went on my husband’s plan, which is good. His company is big enough employees can choose what type of coverage they want. But most are not that nice.

      4. Jessie the First (or second)*

        Not exactly. Health coverage isn’t person-by-person. Employer-provided insurance is a group contract – the company sponsors a health plan that is offered to everyone. People don’t negotiate individual insurance coverages with a job offer.

      5. Rusty Shackelford*

        Generally, no. If you’re a one-in-a-million employee, you might be able to negotiate something on an individual basis, but the vast majority have no such option.

      6. AvonLady Barksdale*

        In my experience, it’s something that’s offered but never negotiated. Some employers have different levels of plans you can opt for, but for the most part, it’s, “This is our insurance, take it or leave it.” One rarely– as far as I know– can negotiate for the types of insurance offered. As in, if the company does not offer dental coverage, I probably wouldn’t be able to ask for it as part of my compensation.

        1. Lara*

          Ah I see – tbh I was thinking more of a scenario where you took a job on the basis that it offered dental, then they yelled ‘psych’ and you didn’t have it anymore.

          2. Nea*

            This is not necessarily a ridiculous scenario. I once took a job that offered vision care and was handed a coupon to Hour Eyes on the first day. That was the “vision plan” – and the advice that sometimes you could get a better deal elsewhere so maybe I didn’t even need to take their coupon, hint, hint.

            1. Lara*

              Sigh. Like OP’s boss they seem to have missed the ‘staff retention’ bit of benefits / compensation.

      7. Tardigrade*

        Other’s experiences may vary, but health coverage isn’t something I’ve ever negotiated. Employers either offer it or they don’t. But when offered, you’re usually able to choose plans with different coverage/premium options (I have always seen three coverage levels).

        2. Jennifer Thneed*

          Oh, I’ve seen plenty of offerings where there was ONE plan. (I remember once the only thing offered was aimed at younger workers. It had a very low premium, with high co-pay and high deductibles. Didn’t fit my needs well at all, and it was before ACA.)

      8. Alton*

        It’s usually established in the sense that you get the information along with any other benefits-related info. I don’t know how many jobs would let you negotiate for coverage they don’t already offer because usually this is an agreement that the company has with an insurance company. They don’t tailor coverage to each employee. Also, it’s a little unpredictable because the company doesn’t call all the shots. The insurance company might opt to raise premiums or change what coverage is offered based on things like new laws (when the Affordable Care Act passed, for example, some insurance companies had to update their coverage of birth control, for example). So enrolling in an employer-based plan isn’t a guarantee that things will always be the same. There can also be negative changes like a company deciding that they don’t want to cover birth control or something.

        Sometimes you have options when enrolling in coverage. I’m in a state job, and I had a variety of options, like out-of-network coverage, vision coverage, etc. And we have an enrollment period once or twice a year where we can change that if we want (I’m actually debating right now if I should add vision coverage to be safe).

      9. Genny*

        It’s never been that way in any job I’ve had. The company has it healthcare packages, and I can sign up for one of them (i.e. I can opt into a better, more expensive premium plan or I can go with a less comprehensive, but cheaper premium plan).

        There are probably some people out there who can get the company to pay the premium as part of their compensation package, but I imagine you’d have to be a pretty competitive candidate in a pretty competitive field for that to happen.

      10. Jam Today*

        No, group policies are not negotiated per member, they are negotiated at the group level, with benefits and costs applied equally for everyone covered under that policy. You can take it or leave it, but if you leave it its up to you to get your own insurance, which can be very expensive for individuals or families.

      11. Jennifer Thneed*

        No, the type of health coverage is not something that is typically negotiated. What is true is that companies will often have 2 or 3 options of level of health coverage, that offer different premiums, co-pays, deductibles, prescription prices, etc. So employees make those choices as they sign up for various benefits, but they don’t get to negotiate a lower premium.

        (That said, it’s probably happened somewhere, at least once. But probably for some high-powered VP or salesperson.)

  8. Cordoba*

    If he’s concerned that people are “frivolously” using their heath benefits because individual premiums are low then a better solution would be to find a plan with higher premiums rather than hounding people about their medical choices.

    Fine, bump my co-pay by $50 if you must. But then screw off about it.

    1. JustaTech*

      Literally the only “frivolous” use of health insurance I’ve ever seen was a guy I knew who went to the hospital for an IV for a hangover (from a work-related event).
      How often does this CEO think this kind of thing is happening? Or is he the kind of person who thinks any trip to the dermatologist is “frivolous”?

  9. Laura Cruz*

    He’s not exactly wrong about chiropractors (it’s extremely well-documented that chirpractors are not practicing actual medicine and a shitton of them promote anti-vaxxing), but that’s not really his place to get involved. If the insurance policy covers it, it’s not his job to tell employees what they can and can’t do just to save money.

    1. Anonymous Poster*

      Honestly, if he doesn’t like them, then he should look at an insurance provider that doesn’t cover it. There’s no need to blast out emails and bring down morale everyday, when he could take a lump at insurance renewal time instead and cut out the things he has issues with. I don’t think chiropractic care is mandated to be covered.

      1. Seriously?*

        Exactly this. If he wants to regulate how employees use the insurance plan, he needs to find a plan that only covers things he is ok with. Otherwise he needs to mind his own business.

    2. Not really a Waitress*

      I was working with someone this weekend who ended up in the er with an injury. She says the woman working on her got mad when she wouldn’t sign up for some program (with a fee) and hit her on the back so hard tissue was torn. I have never seen one. I know people who swear by it.

      1. Observer*

        That’s horrendous. But this has ZERO to do with chiropractic. This has to do with someone who has zero ethics and zero emotional regulation.

        This person should be facing assault charges. And should not be allowed to engage in any profession that entails caring for any other person.

    3. Quack quack*

      “He’s not exactly wrong about chiropractors (it’s extremely well-documented that chirpractors are not practicing actual medicine and a shitton of them promote anti-vaxxing), but that’s not really his place to get involved. ”

      It’s absolutely his place to get involved. In the United States, employers are intensely involved with providing health insurance. Where this guy has missed the mark is in constraining his employees’ use of a benefit provided *as a part of their compensation.* It’s as if he were trying to claw back base salary payments from them. He would be entirely within his rights, however, to select medical insurance plans that excluded chiropractic “care.”

      1. Jessie the First (or second)*

        I have never visited a chiropractor so I have no personal investment, in this, but you REALLY need to knock off the scare quotes and condescension about chiropractic care. It’s not relevant to the letter and is rude to others on this site.

    4. Liane*

      He may not have a choice. Sometimes laws mandate these things.

      Either way, the whole debate about chiropractic/alternative medicine is both irrelevant and annoying in way that the thread about “Can Americans negotiate health plans?” isn’t.

  10. Observer*

    As Countess pointed out, penny wise and dollar foolish (unless he expects people to not stick around the place more than a year or two.)

    You can be sure that if your insurance covers it, there is a good chance that there IS scientific basis for it. Even high cost plans tend to avoid treatments without a solid scientific basis. The low cost ones? For sure. Now, if you told me that your insurance does not cover something, I would not assume that it doesn’t work, but in the reverse? This is how these companies make money.

    1. Not a Mere Device*

      Unfortunately, that’s not always true. The people making those decisions at insurance companies are no better at identifying which treatments work than the rest of us are: they too may think “it worked for my aunt” (who might have gotten better with or without that treatment) or “I saw it on Dr. Oz, it must be real.” I can know “this person had cancer, used this treatment, and is better now” but that doesn’t necessarily prove there’s a connection, especially if the person used several different treatments.

      Also, sometimes it’s not up to the insurer what to cover: if a state government requires that something be covered, it’s going to be because of sufficient lobbying, calls from constituents, etc. Sometimes those decisions are science-based, but not always.

      1. Observer*

        The people making these decisions are looking at this stuff VERY carefully. They don’t care what worked for them or their family. They care about what cuts their bottom line and what is proven to work, because if it’s not proven to work they generally are not required to cover it, so they won’t unless it somehow saves them money.

        Now, the issue of political pull might possibly work here, but I’d be very surprised. Insurance companies have managed to fend off a lot of clearly beneficial requirements (even now, with the ACA.)

        1. Eliza*

          Interesting. In my country (Australia), it’s very common for insurers to offer plans that cover fringe therapies like homeopathy or reiki, not because they’re proven to be effective but because there’s enough demand that people will pay extra for a plan that offers them. It might work differently in a country where most people’s insurance policies are chosen for them by their employer, though.

  11. CatCat*

    Creepy, invasive, and icky because surely those with the need to use it may have a sense that they are somehow blame worthy if costs go up, and wonder will the boss know and be side eyeing them for it. (Thanks for getting cancer, Dan, and just ruining us for the rest of us! Should you really have gotten pregnant, Alice, its expensive!)

    Aside from the grossness, I’d have a worry in the back of my mind about solvency of the company if they’re picking discouraging biopsies because they’re worried about plan costs rising.

  12. Wannabe Disney Princess*

    I had a coworker who has cancer.

    She has surgery about once a year. My boss had a meeting with her and told her the company was concerned because she was costing so much money on the insurance and was there something she could do about that. She raised an eyebrow and asked if they assumed she got cancer on purpose or would they rather her just stop treatment altogether?

    Notice the past tense at the beginning? THIS is how you drive out good employees.

    2. Snark*

      “Well, I have cancer. I guess I could always just let it metastasize and die horribly several months later – is that what you had in mind? Because that maybe doesn’t work for me so well.”

    3. CityMouse*

      Jesus Christ. I would seriously walk out of that meeting and schedule a consult with an employment attorney.

    4. The Original K.*

      Yeah, if you start badgering me about how much I use the benefits you gave me as part of my compensation, I PROMISE you I will start job-searching that day.

        2. BRR*

          Ugh one crappy part is this gives them exactly what they wanted anyways. I’m sorry for your coworker.

          1. Observer*

            If they are that stupid, it WILL come back to haunt them. Because turnover costs money, and losing good employees costs money, and developing a bad reputation also costs money.

          2. Lara*

            Except Wannabe Disney Princess is job hunting and I bet a bunch of her colleagues are too. And it’s a lot more expensive to hire than to retain. Karma y’all.

    5. Amadeo*

      Heh, my place of employment has made some chances to the insurance we got over the two years I’ve been here and while they were in the midst of getting employee feedback, mentioned we had a lot of people utilizing the insurance at very high cost and would we be possibly willing to drive to Nearby City a couple hours away for our medical care as a group whole?

      I mean, I get that we’ve recently undergone some budget troubles induced by Outside Forces, but I’m not really willing to take an entire day off for a yearly physical, no.

        1. Amadeo*

          The question was posed, at least, yes. It wasn’t really a demand, so to speak, but the proposal was tossed out there. Not surprisingly, I don’t think m/any folks took the bait.

      3. LurkNoMore*

        Yeah, we got a memo a couple of years ago asking us to seriously consider having surgeries performed outside of the country where the cost would be lower.
        The company would pay for your air travel back and forth and you could make a vacation out of it!! Never mind if you had need for any follow-up care or complications from the surgery itself.

  13. Anonymous Poster*

    The costs are a major consideration, and this is why some companies have wellness initiatives and literature on preventive care and healthy lifestyles that they distribute. Others run competitions to encourage healthier living (Like a so-many-steps a day program, or participating in a phone coaching program, or a quit-smoking initiative) or penalize smokers through higher premiums, or what have you. I think they’re mostly annoying, but they’re a common enough way to handle it.

    I think your best avenue here is to approach your boss and suggest some of these sorts of things, and not the emails he’s been sending. It allows there to be professional distance between someone’s medical history and the company, which is really valuable for the work culture, fits with what one could expect in another company, and isn’t out of the mainstream. I don’t know how effective these programs actually are at controlling costs, but they are aimed at exactly doing that, which is his concern. Make sure to help him frame all the conversations on, “We want to control healthcare costs through these programs, otherwise your health insurance is your own business and part of our benefits package.”

    You can’t change his mind on whether or not he thinks some things are frivolous. If he is concerned about those sorts of frivolous healthcare costs, then his best solution would be to shop for an insurance provider that only provides those things he believes aren’t frivolous. It would likely not be a great option, but honestly, I think it’s better than emails telling me whether to get my cyst looked at or not. But, that along with commonly instituted wellness initiatives across various industries, along with an agreement to butt out of employee’s health insurance usage, is probably your best solution here.

    Good luck.

    1. AnonEMoose*

      I really hate those company-sponsored wellness programs. And every year, since I have the option, I flatly refuse to fill out the health evaluation thing they want us to do (even though it means not getting the company contribution to the HSA).

      I do not need or want them bugging me to lose weight or exercise more or whatever. The one time HR emailed me a reminder about it, I responded that I was not intending to fill it out, as I find these intrusive. They haven’t bothered me about it again.

      Do I sound cranky about this? Because I definitely feel cranky about this. I think companies should make information available to people, run the competitions if they must (but don’t try to force people to participate), make it as easy as possible for people to seek health care (including mental health care and dental care) when they choose/need to. And otherwise, STAY OUT OF IT.

      1. Michelle*

        PREACH AnonEMoose.

        We have a company-sponsored wellness program at work. After a metabolic panel you get sorted into the low, medium or high risk category. Then there are mandatory things for each level. Low risk have to attend 3 “healthy breaks” per year, medium risk attend 5 “healthy breaks” and meet with the health coach 3 times per year and high risk has to attend 6 “healthy breaks” and meet with the healthy coach every other week. Each “healthy break”/coaching session counts as a point and each category has to accumulate X amount of points.

        Most of the “healthy breaks” are a single sheet of paper discussing the topic of the week and the healthy coach pretty much reads straight off the people. Actually, the health program has had the opposite affect on me. Since it’s inception, I have had to have the following procedures:
        *2 biopsies on uterine spots to determine if they are cancer
        *endometrial abalation
        *all 4 wisdom teeth removed (I was over 35 when this happened)
        *hysterectomy
        *diagnosed with hypothroidism
        Now I know the healthy program did not cause any of these, but the healthy program did not “catch” these either. All were found and treated during routine physicals or in the case of the wisdom teeth, when I complained of gum swelling & pain at the dentist. It’s just a little ironic that none of these things were problems until after the healthy program was introduced. I always tell the healthy coach that the wellness program made me sick.

        1. Clare*

          Was the healthy program supposed to “catch” those things though? That’s really not the purpose of most of those programs. It’s just to offer incentives to encourage people to consider and choose better options for themselves (notice that it is better options for *themselves*, not better options in general, as those options will of course be different for each person) in the hopes that it will decrease their risk of developing certain preventable diseases.

          That obviously doesn’t mean that people will never get sick. I can eat vegetables and wear sunscreen every day and still get skin cancer. But that doesn’t mean I shouldn’t do it, or that eating vegetables had anything to do with getting skin cancer and therefore I should switch to eating pizza instead.

          1. AnonEMoose*

            Maybe encouraging better choices is the intent. But I have yet to see one of these that is implemented well. The program described by Michelle seems to me to be very intrusive, hectoring, and shaming, with a side of telling people stuff they probably already know.

            Not to mention that it seems quite possible for people to guess which group a given coworker falls into, based on their attendance at the “healthy breaks” things, and that would really put my back up, personally.

            Part of it for me, too, is that a good friend ended up in one of those “coaching” things that was supposed to encourage and support weight loss. But if Friend lost a pound in a week, why wasn’t it two pounds? And Friend really needed to prioritize this, etc., etc. It was…really not helpful, and the “coach” was really not willing to consider everything Friend has going on in her life (hint: it’s a LOT). So, yeah…so long as I can avoid participating in some corporate wellness thing, I’m absolutely going to avoid it.

            1. Not So NewReader*

              That’s not coaching, that’s NAGGING. Yeah, people do SO much better when we nag them. Not.

          2. Michelle*

            I was just trying to point out the irony that until the wellness program was introduced, I had been perfectly healthy (according to my doctor). Once they program begin, suddenly I had all these medical conditions crop up.

            They supposedly screened the participants for all kinds of cancer and other things that can be diagnosed through blood testing. The part that I never understood was they would screen you for all types of things (diabetes, triglycerides, blood pressure, cancer, etc.) and if those things came back out of the normal range, they would just suggest that you see your doctor. So, if you are having yearly physicals those are the types of things your doctor would screen for anyway so why implement a program that does the same thing? As AnonEMoose mentions below, I felt it was intrusive and I get nothing out of it, beside I need to work on X, which my doctor has already told me. He also helps you find and set up an appointment with a dietitian/nutritionist to help you with meal planning, etc.

            Also, again as AnonEMoose mentions below, everyone knows which group you are in. They do not take into account if you have a chronic medical condition and are working with an actual doctor vs. the wellness coach. The wellness coach appointments are pointless. They ask me what I want to work on and I tell them what I amworking on with my doctor so they want to pick something else. I can’t spend every non-work moment I have working on X thing for my doctor and Y thing for the wellness coach but if I want the wellness program deduction for my insurance premium, I have to participate. I thought about not participating, but that additional $600 yearly for insurance would be

            1. Michelle*

              Sorry, hit enter before I finished. The additional $600 a year for insurance if I don’t participate would wreck havoc on my budget.

            2. Michaela Westen*

              I thought the blood tests were for people who aren’t seeing a doctor regularly, but I don’t know. It’s more convenient to get it done at work.

      2. Michaela Westen*

        For the first few years at my job the health program was a little ridiculous. It was automated so it would ask me questions like what do you eat? And when I told it it said I should eat dairy. I’m allergic to dairy. I can’t eat lettuce, onion or garlic because they upset my stomach. And so on. There was no place to enter this food information.
        I mentioned this in surveys a couple of times and it went away… Now they just provide info and the yearly screening. I think they require people who fall outside their parameters to get coaching, but so far I haven’t.
        I was underweight, still not where I was – but their paradigm doesn’t include that, so if you’re not overweight they give you a pass…
        But I’m sure it’s helping people in some ways.

        1. AnonEMoose*

          Granted, I’m a confirmed cynic about these programs, but I wouldn’t be sure that it’s helping people at all. I would definitely question the qualifications of the coaches, for one thing. For example, do they have actual qualifications (like being nutritionists or nurses or something like that), or are they just provided a bunch of scripts by whoever is administering the program?

          How much training do they have to work with people who are chronically ill, who may have complicating factors like mental illness, a disability, allergies or food sensitivities, or any combination thereof? And are they bound by HIPAA or other confidentiality requirements, so that information people may disclose as part of this process is handled appropriately?

          Or is it basically a poorly fitting band-aid for a complex problem, that ends up becoming an excuse to shame and interrogate people, under the guise of “concern for their health”?

          1. Tim Tam Girl*

            I swear I’m not nitpicking, but your comment brings up an interesting and useful point: ‘nutritionist’ is not a protected term in the US (or any of the Commonwealth countries, I believe), by which I mean that it’s not a regulated profession that requires you to have certain qualifications before you can call yourself a nutritionist. ‘Dietician’ and ‘registered dietician’ are the protected terms, which mean that people must have recognized professional training and qualifications in the field before they can call themselves either one.

            Some US states require that nutritionists register with a state Board, but even those requirements vary widely; and in many states, you don’t need to have any kind of training or registration whatsoever: you can just declare yourself a nutritionist and start giving advice for pay. Patients/clients trust the title without realizing that it’s not necessarily tied to anything.

            I’m not trying to get all sandwiches here; I’m sure many people have had great experiences with nutritionists. But if you’re ever seeking dietary advice, especially for anything to do with a health-related/medical condition, it’s really important to understand the difference in qualifications and regulation.

            1. AnonEMoose*

              I don’t think that’s nitpicking; I think that’s a really good point, and something it is good to understand. And, really , if my company ever tries to force me to participate in one of these, the questions about qualifications and so on are ones I plan to keep in my back pocket to ask. And keep asking until I get answers. Because I can be annoying like that when I want to be. And pedantic. I spend quite a bit of time with academics and with geeks. I can do pedantic All. Day. Long.

            2. Michaela Westen*

              Thanks Tim Tam Girl! I had forgotten that.
              My experience with both dieticians and nutritionists is I’m way beyond what they know about food.
              Of necessity since I’ve had to learn how to eat around my problems.
              So I want to add that even if you’re working with a highly qualified dietician, it’s also good to think for yourself and pay attention to your body. That’s the final word.

  14. Parenthetically*

    Ah, “a small tech startup.” Words that, like, “We’re like family,” will forever make me want to run for the hills.

    2. Daughter of Ada and Grace*

      I get the feeling that the founder heard “Offer good benefits to attract good employees”, and didn’t understand that you also have to let the employees use those benefits if you want to keep the good employees.

  15. LSP*

    Unless your boss is 100% sure that he doesn’t have a single employee who has a disability (which he really can’t be) then he is treading on some potentially sticky ground, since individuals with disabilities are protected against discrimination. If this guy is discouraging people from getting the care they need to deal with a disability (like some invisible one: depression, anxiety, even migraine) that could easily be viewed as discrimination.

    He needs to BACK OFF this topic immediately.

    1. Not really a Waitress*

      I immediately went to the episode of the Office where Dwight is told to pick a health care plan for the office.

  16. Snarkus Aurelius*

    If you don’t want people to use the health insurance, then don’t offer it as a benefit. Is this guy the AOL CEO who criticized an employee’s child’s premature birth because the CEO claimed that’s why there was a big loss that quarter? (I’m not kidding. Google it.)

    I’m reminded of an old boss who was super cheap when it came to support staff. One time, one employee at a conference used room service to order lobster. Even though this happened when I was in elementary school, we all had to listen to a lecture *before every conference* about what food was appropriate to order and what wasn’t and how we should always eat meals at the conference because they were already paid for. It got to the point, I’d rather they not offer to reimburse for meals at all.

    2. Jam Today*

      This is completely tangential, but if I’m traveling and my food costs are per diem rather than having fixed limits for each meal, and I get Dunkin Donuts or freaking trail mix while I’m in transit because I don’t have time or access to anything better, you better believe I’m blowing the rest of that per diem on a really nice steak dinner.

      1. Quickbeam*

        I’ve done that…I had a job where I was on the road as a public health RN covering the entire state. Our food allowance was per day and once I blew it all on a fancy dinner at a restored diner.

    1. CityMouse*

      It depends on who he is targeting and how (and where they are located). If it becomes a serious issue, OP should consult an employment attorney in the relevant jurisdiction.

    2. Argh!*

      I can see litigation happening whether it’s technically legal or not. If someone forgoes medical treatment to please the boss then dies, the family will come after the company.

        1. Argh!*

          Even if the plaintiffs didn’t prevail, the costs of the legal fees will outweigh whatever break the company may have gotten from the insurance company.

      2. mark132*

        Even if it doesn’t go that far, the whole thing sounds penny wise and pound foolish. Preventive care combined with early interventions can minimize major illnesses that could cost the insurance much more.

        To give the guy a small bone. I don’t go to the doctor for stuff like basic colds, or simple stuff like cuts or such. Because it is a waste of time and money.

        1. Observer*

          Of course. If that ever changes, it won’t be because an employee dies. It will be because something hit HIM.

    3. McWhadden*

      It’s probably mostly legal. The problem is if he’s discouraging people with recognized disabilities from seeking treatment. Then he’s violating the ADA.

      Employers getting all up in their employees medical business isn’t new. A bunch of people pointed out that truly revolting AOL thing. But there is also the Hobby Lobby case where they fought to not cover their employees birth control. The Catholic Church did, as well.

  19. Quickbeam*

    I’m all for educating employees on legitimate ways to save health insurance costs. Emergency room visits are a terrible way to get routine health care. My company actually has an in house clinic at the home office for day to day stuff and it is free. Also there are some terrific ways to reclaim your power over health information like Life Extension. But no one should be dissuading people for using their health insurance.

    1. Bea*

      The thing is when you have health coverage most do not go to the ER. First it’s a $200 copay and second they have access to a better system! Most folks we see going to the ER with issues they should be treating otherwise, effectively driving up costs everywhere because they won’t pay the bill later anyways and the ER has to see you, insured or not, those are our uninsured or underinsured citizens.

      1. Quickbeam*

        You’d be amazed at how many people with insurance see the emergency room as their first line of care. I’m an RN with 30 years of insurance case mgt experience. It still surprises me every day.

        1. Bea*

          These are why the waiting rooms are such a nightmare and those with real emergencies die in them every year OMFG

          That’s also due to uneducated people or who are too scared or confused as to how to make an appointment with a GP.

          1. Lara*

            This is a huge problem everywhere I think – the NHS recently ran a massive education campaign about it complete with flow charts. Like “if you have a cut, use a plaster. If you think you have sprained your wrist, go to your GP. If the bone is at a funny angle, go to A&E (ER).”

        2. A Non E. Mouse*

          I wonder how much of this is because urgent care isn’t open at that particular time?

          My family is injury-prone on holidays (I wish I were joking) and there’s been more than a handful of allergic reactions (Xmas day), stitches (4th of July, Easter), blown knees, broken hands and concussions (Labor or Memorial Day) that really just needed minor medical attention or evaluation…but literally none of the urgent care places in the metro area were open (either closed all day, or shut down early due to the holiday).

          We avoid the ER if at all possible (including resorting to super glue in borderline stitch situations) because it’s an $800 copay.

          {If I listed all the times we did go to urgent care or the extended clinic hours our own doctors offer, we’d be here for weeks.}

          My very long-winded point is that some “managing health care costs” tips can be useful – like “did you know these health- and urgent-care clinics are in network and are open until 8pm each evening”.

        3. Goya de la Mancha*

          And the amount of people who utilize the ambulance like their personal taxi for said ER visits.

          2. Detective Amy Santiago*

            I’ve actually seen references to people taking Uber/Lyft to get to the ER because it’s cheaper than paying for an ambulance.

      2. Judy (since 2010)*

        My current company has somewhere between 2,000 and 3,000 employees. Our HR manager has shared with me that there are usually 200+ families that have more than 6 ER visits with no hospital admissions every year.

        This is at a company that has on site health clinics and access to the area’s largest urgent care networks.

        That’s why our company has increasing co pays for each ER visit with no hospital admissions, first two are $300, after that $100 more each time. The 6th visit would have a copay of $700.

        1. Bea*

          Do they have kids? I was in the ER a few times due to my accident prone ways as a kid. You don’t get admitted for a broken bone…

          Being admitted means they transfer you from ER to the hospital for care. If it’s stitches or a cast, you’re not considered admitted.

        2. RemoteTeapotInspector*

          I live in a small town and have two asthmatic children. We are relatively frequent fliers at the ER because on nights/weekends there aren’t other options. When we visit during the day, the doctors office usually sends us to the ER for further monitoring and X-rays. It’s not always what it seems.

          1. TL -*

            A company with 2-3000 employees, an onsite health clinic and access to a large urgent care networks is probably at least in a small city/urban area.

            In a small town you go to the hospital (or vet’s office, sometimes…) because there aren’t any other options. In a city, urgent care is usually open early to late and cheaper/better for dealing with small stuff, plus there are better monitoring options for specialist care.

        3. Julia*

          I’m a woman of almost 30 and I’ve been to the ER three times in my life, without being hospitalized even once. The first was for a car accident where I wasn’t really injured, but the cops told us to get checked out anyway (ER found a whiplash injury), the second was sudden and excruciating stomachache that the ER couldn’t find a cause for and discharged me, the third was a series of freak events where I ended up half fainting in the restaurant of a clinic my colleagues and I often ate at, where the staff (!) told me to go to the ER to get that checked out, where of course they found nothing and discharged me.

          Does that mean I’m using the ER frivolously? Believe me, none of those three times, I wanted to spend the entire day/night in the ER being poked with needles and belittled by doctors for not being sick enough.

          1. Not a Mere Device*

            My most recent ER visit involved an ambulance ride, a few hours of rest, testing, and rehydration, and then being sent home. I didn’t want to go to the ER, but both my spouse and the EMTs he’d called after I fainted thought I should. It turned out that walking several miles on a hot, sunny day, and drinking lots of water to keep hydrated, can lead to hyponatremia and passing out from low blood pressure.

            The EMTs and the doctors I saw agreed that I had done right to call them. In my case, all I needed was to rehydrate, and remember that if I walk four miles in the sunlight again, I should drink something like Gatorade, not just plain water (even though water tastes better). But we couldn’t know that when we were sitting in my living room. Sometimes people die from “it’s probably nothing” and “don’t make a fuss, there are other people who need the doctor more than you do” and “I don’t have time to get this checked out.”

      3. Mookie*

        The belief that under- and uninsured Americans visit ER and urgent care facilities more than fully insured Americans is not true. What is true, however, is that the former group is less likely to seek and has far less access to preventative medicine and outpatient care.

        Link in the next comment.

  21. overcaffeinatedandqueer*

    Personally, I think chiropractic medicine is kind of, well, crunchy or woo-y unless you actually have serious neck or back problems that can be relieved by the adjustments or massage. (Some are really sketchy and some people use them instead of regular doctors). But, if insurance covers it and you need something, it’s your right to use said thing. That’s why you have insurance.

    1. Anonish*

      I was very pleased when I started going to the chiropractor that mine has printed signs in every treatment room displaying the list of conditions that chiropractors can treat. They’re all back/spine/muscle-related, and nothing like asthma or lupus.

      1. MyBossSaidWhat*

        See this is the problem – and certainly not just you – chiropractic care does have a basis in science. Just because you (general, I don’t have. Medical background either) don’t understand how it works and/or it hasnt worked for
        You personally doesn’t mke it “woo woo”.
        It’s a slippery slope for a job to make judgement calls about the necessity of employees’ medical care. Your boss doesn’t get a seat at the table!

  22. HR Recruiter*

    I’ve handled negotiating annual insurance increases for employers that size. What he is is doing is good in theory but he’s totally doing it all wrong. Educating employees on what types of services to use for what, is huge in reducing or maintaining your rates. But discourage use is not at all ok.
    Assuming you have broker reach out to them. They should have something already put together or can put something together for you. Typically they will give you a list of when to go to doc, when to go to emergency room, when to go to ER. If your doc wants you to have x-ray, MRI, blood-work done they usually send you to a hospital. Your broker can give you a list of places that will cost a fraction of the price. Since you have a young healthy group a lot of people probably don’t have a PCP so this information would be useful to them.
    We had employees going to the ER for mild pink eye because they didn’t have a primary care doc. Things like that drive up your rates.
    Side note-your boss is crazy. Going to a chiropractor isn’t going to drive up your rates with a group that size. And Chiropractors are amazing!

    1. kb*

      This is a great and really helpful comment! It seems like for all the boss is talking about trying to save money on healthcare, it is he who needs to be educated on how to save on healthcare in the long term.

    2. Indie*

      Yeah I’m really hoping this is what boss was trying to do but just isn’t very good at the advice required.

      1. HR Recruiter*

        Another reason to get the broker involved. What ever is intention is he his main goal seems to be to save money and they can easily put it into money saving terms for him. And let them be the bad guy instead of OP. They should have plenty of evidence to support why he needs to stop what he’s doing. For example a biopsy costs $ and not detecting cancer early on costs $$$$$$$$$.

  23. Guitar Hero*

    Unless you are a health practitioner yourself, I’m not sure why your boss would put you in the position to even attempt to advise others on how to eat healthy and exercise. You don’t want to be dispensing advice on those topics without the proper licenses… unless you’d like to have to get rid of healthcare to cover the costs of the lawsuits.

    When I log into my insurance provider website, information of that type is already there anyway. Perhaps you can leverage what you’re already paying for by just encouraging people to use their personal portals and getting information there.

    1. Bea*

      Or you can print out and distribute the information, many people do not log into their portals or explore that kind of thing.

      We only distribute paperwork from our provider and agent.

      They don’t want you to file claims either, they make more money if you pay premiums and never see a doc!

    2. Cordoba*

      Many organizations provide general health, exercise, and wellness advice that does not come from a doctor or somebody else with “proper licenses”.

      The quality and appropriateness of this advice may be suspect, but I don’t think it often results in lawsuits. In a few minutes of searching I’ve not found a single case where an employer or individual was sued solely as a result of giving general health tips. Are you aware of one that I’ve not been able to unearth?

      1. Guitar Hero*

        I’ve never seen cases of employees coming after their employer, but there have been cases of state licensing boards coming after individuals for offering nutrition advice without being licensed. The most notable one I recall was from North Carolina, and I believe the guy actually won, but still… who wants that hassle?

  24. Oxford Coma*

    He’s right, you know. Eating a ton of salad and working out constantly has fixed my severe astigmatism and hypothyroidism. Turns out my lenses and glands were just being lazy.

    /s

    1. Rusty Shackelford*

      At least, I assume they’re fixed. I haven’t gone to the doctor to confirm. It’s discouraged.

    2. Detective Amy Santiago*

      Except right now it’s not even healthy to eat salads (at least not with romaine lettuce).

      1. Liane*

        Yes, I saw a great meme yesterday about how chocolate is now good for you but romaine will kill you dead!

        1. A Non E. Mouse*

          That was great, my husband shared that with me. It ended with “I’ve been training for this day my whole life!”.

  25. stitchinthyme*

    Oh wow, does this give me flashbacks! My boss at my last job wasn’t *quite* this bad — he never got to the point of sending out missives on appropriate uses of health insurance — be he did repeatedly try to convince a coworker of mine not to have his gall bladder removed because of the insurance expense. He tried to tell my coworker that his condition could be controlled by diet (no, my boss was not a medical professional of any sort), and when that didn’t work, he never lost an opportunity after that to point out that it was my coworker’s fault that insurance premiums went up…and also the fault of those who had voted for Obama. From then until I left the company, I was constantly afraid of what would happen if I or one of my other coworkers should get some condition or injury that required really expensive healthcare.

    1. Observer*

      I’m trying to wrap my head around this one. As you point out, gall bladder removal is not even all that expensive as these things go.

      Did your coworker ever have an attack at work? I suspect that the disruption caused by a really bad attack might convince him that it’s not so cost effective to get people to not do the surgery.

      1. stitchinthyme*

        Not that I’m aware of (and I’d probably have known since I sat right next to him). Boss just decided that the surgery wasn’t necessary and did his best to convince my coworker of that.

        Amazingly, this wasn’t even the last straw for that coworker. Instead, it was when he asked to alter his schedule slightly — he’d just moved a bit further away to be with his formerly long-distance girlfriend, and if he came in at the normal time, he’d have to leave 2 hours before that because of the horrendous traffic, whereas if he came in a bit earlier or later, the trip would take a half-hour or 45 minutes. This was a software development company, so there was no real need for a rigid start time, but Boss said no and suggested Coworker leave his girlfriend and move back closer. I overheard this conversation since he sat right next to me, so I popped my head out of my cube and said to the boss, “Wait a second…you want him to move and leave the love of his life…for THIS place??” Boss kind of hemmed and hawed but still refused the schedule change. Immediately after that conversation, Coworker started looking for a new job, and found one within a couple of weeks.

        So yeah, this boss was kind of insane.

          1. stitchinthyme*

            Yeah, they’re still in business. This is a small company (fewer than 20 people) owned by one guy, and those are by far not the only stories of him I could tell. I mean, he wasn’t “you must submit to testing to donate part of your liver” bad, but he was definitely among the worst bosses I’ve had. I heard through the grapevine that after having several longtime employees (myself included) leave within a relatively short time, he did get a bit better — when I had my exit interview, I did tell him exactly why I was leaving. (My main reason: only one raise in nearly five years there. In the software industry annual increases are very much the norm, and that place remains the only company I’ve ever worked for that didn’t do that.)

  26. Bea*

    Ah your boss is showing his crazy. Most CEOs hate healthcare costs but know it’s necessary and I agree educating everyone is important but he’s going about it so wrong. All it takes is stripping out the “don’t use it!! Don’t visit chiropractors!!”, get a plan without chiropractors and acupuncture covered for starters, argh. I’ve worked with mostly labor intensive work forces and those guys will riot if you take away their semi regular chiropractic visits though. Tech may be more accepting of not having the option covered.

  27. Glomarization, Esq.*

    Smells to me like the company has a cash-flow problem. LW, keep your resume polished up.

    2. Bea*

      Nah, every employer is wringing their hands over insurance costs no matter cash flow.

      Many CEOs take a cut of profits and they don’t get that extra ivory back scratcher at the end of the year if they “splurged” on insurance for the staff.

      1. Coffeelover*

        This is so… well put. How greedy do you have to be to put your profit above the health and safety of the people that are literally making you the money. What is it about wealth and power that makes some people lose all decency. :(

        1. Bea*

          It’s the bad taste insurance companies put in our mouths in the American system coming into play as well. The costs are outrageous and do stand out when you’re viewing your financials.

          I have short term disability coverage and I am so angry and disappointed with the half ass carrier if I weren’t a well educated person who knows it’s a necessity to anyone who isn’t wealthy and even then it’s smart to have for a safety net, I would just flush it.

          They’re really not all villains but they’re pigheaded dingbats looking at the money not the whole picture let alone seeing humans who are busting their asses for the place who are being taken care of.

        1. Bea*

          Thank you for getting it. I say it all the time and people are like “who da fuq uses backscratchers and ivory is illegal!!!” lol

      3. INTP*

        If they let that attitude show to their employees, though, the employees quickly lose their sense of responsibility towards the company finances. If you make people feel like they’re stealing from the company when they use their health insurance or take a vacation or drink an extra cup of coffee, they will quickly become numb to the sense that they’re wasting company resources when it comes to spending half the day slacking off when they can get away with it, placing orders at the last minute and paying rush fees instead of planning better, not keeping their travel costs under control, etc.

      4. Observer*

        True. But most CEOs also understand the limits of what you can do with it.

        A lot of people have mentioned the AOL mess. Well, guess what? AOL *was* having major financial problems. Case was trying to disclaim responsibility for it. I’d be willing to bet that if the company were in sound financial health, he would never have mentioned it.

    2. A Person*

      Me too. Toxic job management treats older/sicker employees a lot worse than the young healthy ones because with our awesome health insurance, the older employees are less likely to leave.

  29. mintypins*

    Benefits specialist here. This is actually more than sketchy — if someone has a protected disability that might require costly medical care, and the boss is aware of this, that is bordering on discrimination. Not to mention, some insurance companies will issue anonymized data about what types of care the plans are using — usually if you have 50+ employees covered they can issue that information to the employer. But 80 close-knit employees makes it pretty easy for the boss to try and guess who is being treated for what — not to mention that if someone has an active accommodation in place at work, it would be fairly easy to figure out which costs were theirs.

    So that makes me concerned, because who’s to say that, since this boss is already over-involved in employees’ medical decisions, that this situation won’t escalate to where he is pointing out that one person is using the insurance, say, for mental healthcare, and the staff being able to piece together who that might be. That is a violation of HIPAA as well as hugely inappropriate and possibly discriminatory.

    You can’t sabotage people’s benefits, ESPECIALLY health benefits. That being said, the wellness piece of it is really common. I don’t see that as a bad thing, necessarily — giving employees information about prevention benefits employers and employees. But that is way different than treating certain medical procedures as frivolous and actively discouraging use of health benefits.

    1. Dzhymm*

      I’m just curious… to what extent are company insurance premiums based on claim history? If one of my employees is unlucky enough to get cancer are my premiums really going to skyrocket next year? Doesn’t that kindof defeat the purpose of “insurance” and “pooled risk” and all that?

      1. mintypins*

        Claims history is definitely a big factor. Generally, once your overall % of cost increases above a certain threshold, that usually results in either an increase in premiums or an alternate proposal that puts the added cost somewhere else. So sometimes that will mean premiums are the same but deductibles increase by $1,000, or copays go up from $25 – $50, etc.

        So yes, if an employee gets cancer and there is a $1 million dollar claim (which can happen), it isn’t uncommon to see some increase the next year, especially if the group is smaller. With larger groups there’s more of a cushion because the company is seeing more money from the group in the form of premiums.

        That’s why we have brokers and other people who negotiate on companies’ behalfs, and also why wellness programs are good practice — if you can show you’re helping employees stay healthy, sometimes that can be a factor in keeping premiums lower. But it’s just so slimy and disgusting to discourage people from using their health benefits. The system is really broken and expensive, and it sucks when premiums go up, but also people need to be able to use their healthcare.

      2. Anon for this*

        It does. My small firm has Short Term Disability insurance and two employees have used it over the last two years. The rates skyrocketed and we had to find another carrier.

        I also have a very expensive chronic illness and my husband works for a mega sized employer. I negotiated with my employer (who knows about my chronic illness) to pay the difference for me to be on my husband’s insurance instead of theirs since it is saving them a fortune from having their rates increase due to my big risk.

        The rates can also vary greatly based on the age of your employees which opens up another host of issues.

  30. Jessie the First (or second)*

    If this is an ERISA plan, actually preventing people from using benefits or retaliating against people who use it is illegal, and the Dept of Labor cares a lot about that. And if you are writing things about your company’s health benefits, it’d be really good to run it by the people actually in charge of the benefits, because insurance plan documents (the documents the company is required to have when it offers health insurance) are a highly regulated thing and you don’t want to mess with that.

    If he is just ranting about how everyone should magically be healthier and begging them to use less healthcare, then he is a short-sighted idiot. A better use of his time might be to research wellness programs (actual, real wellness programs developed by people who know more than your idiot boss does).

    1. Triple Anon*

      Running it by an authority outside the company is a really good idea! Then anything that gets flagged as inappropriate would be coming from them, not you, but you’d still get to pass it along to him.

  31. Seal*

    You know what helps keep healthcare costs down in the long run? Regular checkups that catch potential health issues early and treating health issues before they become catastrophic. Anyone who thinks that’s a “frivolous” use of health insurance is an idiot.

    Until a couple of years ago I would have called myself a healthy person. But out of the blue I was diagnosed with an autoimmune issue that affects my eyes, resulting in frequent visits to specialists. Within the past 6 months, not only did I have to have surgery on my eyes due to the side effects of the autoimmune issue, I had to have a molar pulled after never having had a cavity my entire life, and will be having surgery soon to repair a torn rotator cuff after falling on my shoulder. None of this was caused by not taking care of myself. Sometimes stuff just happens – that’s what health insurance is for.

  32. Elemeno P.*

    Man, I’m super grateful for my workplace and my team. My department is only 5 permanent people and 3 of us are constantly breaking somehow; I can’t imagine how awful it would be if the other 2 made us feel bad for having garbage bodies.

  33. President Porpoise*

    I get where you’re coming from – but it would be wise to maybe put together a publication on how to be a good self-advocate and how to research the true costs of healthcare options and search for cheaper but similarly effective options. I remember when I took a class on healthcare economics, just before Obamacare passed, there was a lot of discussion about how doctors don’t really know or think about the costs associated with what they are prescribing or the tests they’re running; they find a brand they like and stick with it. One example given was a replacement hip. A perfectly good option went for less than a thousand, but the most popular option – practically the same, except for brand – cost over three thousand. Pharmaceutical companies are really, really good at marketing to doctors, and that can sometimes be detrimental to patients, insurers, and the companies that are sponsoring the healthcare overall – both health wise and in terms of cost. See also the fact that narcotics are not particularly effective at controlling many types of pain (such as back pain), are actively harmful to many people, and are yet seriously overprescribed.

    I think this would be a perfectly ethical way to serve both your boss’s desire to reduce insurance costs and help your coworkers learn to make good healthcare decisions.

    1. Red Reader*

      Oh, god, doctors have no idea about the costs of testing and treatment or what insurance companies will cover under what circumstances. I reverse thousands of dollars a month in charges for lab work because there isn’t enough documentation available in the patients’ charts to get the damn insurance companies to pay even partial charges.
      /medical coding and billing for 15 years

      1. Xarcady*

        My sister-in-law is a doctor. She says that the insurance companies make changes monthly to what they do and do not cover. She decided she had time to keep up with changes in medical practice or the changes in what the insurance companies cover, but not both.

        For example, there are monthly changes in which drugs are covered. It might only be two or three drugs that change each month, but multiple that by 10 or 15 different insurance plans–you can see how that many changes might be difficult to memorize every month. So she writes the same prescription and tells the patient to let her know if the pharmacy says their insurance no longer covers that specific drug. It is not the best solution, but it is the best SIL can come up with.

        Now multiply that by all the different tests and procedures that exist, and multiply that by the number of insurance plans.

        1. Red Reader*

          Oh, don’t mistake me – I don’t have a problem with the docs not knowing the finances. That’s not their job. But too many of them in my experience go “yeah? It should be covered” instead of saying “I don’t know, let’s have the admin staff help you find out.” And the patients, who don’t have the background to know that the doc doesn’t have the foggiest idea, just assume that doc is right, and also pitch wobblies at the office staff when that turns out not to be the case.

        2. Michaela Westen*

          There should be, if possible, a support person in the doctor’s practice who can keep up with that stuff and keep the doctors informed.

    2. Grouchy 2 cents*

      Except that many costs are hidden. Go to your local hospital and ask how much they charge for a hip replacement. They won’t tell you. And it’s not because they can’t factor in which hip you choose. Intead, it’s because depending on which insurance company and which network and which employee plan and deductible and which doctor and time of year and age of patient and general health of patient and on and on the number will be different. And not just within $100 difference but thousands and thousands of dollars difference. There are too many permutations for them to calculate. I think that’s stupid and counter-productive and criminal that the system is set up that way but one start-up tech company isn’t going to suddenly change the entire system.

      Being an educated consumer is a good goal and for things like generic vs brand name drugs you should check. But people shouldn’t be insisting on the cheaper hip (operation/test/drug) just because they’re assuming big pharma is trying to rip them off based on a google search. Many times there is a legit reason to do it one way. Just as there can be a legit reason to use the name brand instead of the generic, or to use this specialist in your network instead of that guy who charges less etc.

      If the CEO of the company wants to do all the research for their employees great. He can bang his head against that particular brick wall all he wants. But don’t expect an employee to spend hours, and I do mean hours, sometimes days, researching every possible option and price differential because it’s not a good use of time.

      1. Not So NewReader*

        Thank you. I think there is a lot of criminal activity going on there. Okay, let’s go with no-ethics-in-sight-anywhere. The double pricing slays me. My friend needed something for an ear infection. The person at the pharmacy said, “That will be $120, please.” My friend said, “WHHAAAT? I don’t have insurance.” The next words from the employee’s mouth were, “Oh. Okay, then that will be $12.” This is insurance fraud.

        I got billed just over $100 for a butterfly bandage on a cut. They deemed it a surgical procedure. My boss called and griped. They dropped the bill down to $35.

  34. peachie*

    Can anyone who knows more about employment law explain what health information your employer can and can’t see (assuming you participate in your employer’s health insurance)? I tried to look this up, but I couldn’t find a clear answer. It had honestly never occurred to me that my employer could have that much access to my health information.

    1. Bea*

      They get blind data when rates are being issued. They can then use that to suss out where charges came from or assume that everyone is going to the chiropractor. You don’t get details like “Jane Smithers has 3 prescriptions, birth control, an inhaler and heart medicine.” or anything like that.

      We couldn’t access how many people actually use our vision plan to see if we even still need it or could jack the copay up and would it even be noticed.

      1. Natalie*

        A couple of not common exceptions – a self-insuring employer does have more detailed information, but the employees that handle that part are not allowed (by law) to share it even within the company, and the company can’t legally use the health care information to inform job decisions.

        I’ve also had one friend whose employer self-administered their FSA (it was a state agency), so they had access to the receipts you submitted. She decided to spend her entire FSA on contact lenses rather than inadvertently share anything personal.

      2. mintypins*

        This ^

        But one more piece of this puzzle — they’ll only issue this data if your group is large enough; usually more than 50 covered individuals. This is for privacy reasons, because the insurance company may not inform employers of which employee is using which medical service due to HIPAA regulations — and if you have five staff members it’s way too identifiable.

  35. Phoenix Programmer*

    There is a fine line between arming employees to make better health hoices and coming across as wanting them to die of cancer for “the greater good”

    My workplace has started doing this as well and while I still don’t like it they are taking more of a “how to be an informed consumer of healthcare”approach.

  36. Ruthie*

    We had an insurance broker at my old job who felt it was acceptable to explain that our rates were going up by saying things like “Well you had a premature delivery and a nursing home stay this year, so your group is super expensive.” We were a small office, so of course we knew exactly who he was talking about. It was awful. He would also say things like “A1 Insurance is so great, they cover preventive care for free!” Yeah dude, we are health coverage policy experts well versed in ACA and other regulations, we know Obaamacare was the one to thank, not A1 Insurance.

    1. hayling*

      Gross. Wasn’t there a tech CEO who got in hot water for saying something like this? The term “distressed babies” comes to mind, but honestly I don’t even want to Google it.

      1. Liane*

        Yes, there are links in one of the earlier comments. But you probably don’t want to check them out. I read about it when it first happened and it’s gross disgusting behavior that will horrify any halfway decent person who reads an account of it.

    2. Xarcady*

      My brother and sister-in-law had a baby who spent six months in NICU and came home with a ventilator, home nurses and the need for a lot of physical, occupational, speech and other therapies. Nephew’s disabilities and medical issues are life-long–they are not going away.

      My brother feels that his employer did their best to force him out of working for them–demotions, getting stuck with the work no one else wanted to do and that was usually given to new employees, changing his job completely from what he was hired to do. But he was afraid to switch jobs, because he couldn’t risk ending up with health insurance that didn’t cover all his son’s needs. (This was before the ACA.) He thinks the only reason they didn’t attempt to lay him off or fire him was that it was a Catholic organization, and the optics of firing someone because they had a disabled child who raised their insurance costs wouldn’t have looked so good. He left when SIL found a new job with great insurance.

    3. Becky*

      I haven’t encountered anything quite that bad, but last year when they were talking about the health insurance and explaining the jump in premium (not huge) and the changes to out of pocket maximums with “there were a lot of expensive claims last year” and some other weasel words dancing around usage of healthcare it pissed me off!–like do you really think that I begrudge the medical care that coworkers needed? That Bob needed both of his knees replaced? That Laura had a baby in the NICU for 6 weeks? That Robert was diagnosed with colon cancer? Really?
      Generally my work does encourage us to use preventative care as much as possible but sometimes they really put me off in other ways.

  37. Coffeelover*

    I wonder if this guy would also be the type to reject a highly qualified 50 year old candidate because of “fit”. How about an overweight candidate or a pregnant candidate or a disabled candidate… Gotta keep those premiums low.

    This is gross on so many levels.

  38. Amy H*

    I once put off getting a “skin tag” biopsied. It turned out to be Melanoma, and it deep enough that they were worried it had spread. Needed surgery + other tests. I’m fine now, but still paying off large medical bills, despite having insurance! DO not put off getting a biopsy. It could end up being more costly in the end.

    1. Observer*

      No! That can’t be true! I mean, MY biopsy was just FINE! It was a TOTAL waste of money! How could yours be any different! You just want some attention!

      /sarcasm

  39. Uncle Bob*

    When a co-worker dies of cancer because she was discouraged to use medical care ain’t nobody going to have any equity left. Perhaps you could point out some legal and ethical concerns with this?

  40. JMJ*

    OMG! WRONG on SOOOO many levels!!

    If you are in the US, you are community rated (under 50 employees) and no matter how many claims you have, it won’t change the rates (if that is what the Boss is thinking).

    If the Boss wants a Wellness program in place, great! Google Wellness programs and you’ll find lots of info.

  41. Strawmeatloaf*

    Penny-wise, pound-foolish.

    This guy probably wants employees not to go in for the “small” things, that later will cost them larger amounts of money and treatment and time because it was ignored at first.

    Is there some class that managers/bosses/CEOs can take that tell them why this is a bad idea?

  42. Katie the Fed*

    “How to stay healthy and exercise” – does anyone not actually know this? Of course we do. How about the company provide some time on the clock for people to go for a walk, if it’s that important? Unless you want to tell me how to fit in an exercise program while working more than full time, commuting, breastfeeding/pumping, caring for a baby who doesn’t sleep through the night yet, two cats, and a dog, and running a house? Any genius ideas on that?

    1. Detective Amy Santiago*

      Treadmill activated breast pump… your walking powers the machine so you can simultaneously exercise and pump!

    2. Bea*

      That’s why company fitness centers are fantastic ideas. An onsite option so you can at least possibly fit in 20 minutes more of exercise.

      Standing desks are also great to offer people.

      There are ways but these half asses want to keep flapping gums and not putting their money where their mouth is.

    3. Knitting Cat Lady*

      Heh, or how to do exercise when you often struggle to get up and put on clothes…

    4. Roja*

      Agreed, in general! But there is a lot (a LOT) of truly terrible “information” out there on being healthy, both nutrition and exercise-related. You’d think it would be a duh thing but it’s really not. I’m a part of two weight-loss forums, both pretty good places overall, and there’s still quite a bit of misinformation that pops up. Luckily most of it is counteracted by knowledgeable people, but still. The more good information out there, the better.

    5. Luna*

      That’s the thing that drives me nuts about companies that claim to value wellness, or “experts” who talk about how to get people to change behaviors. Like yeah, there are always some easy modifications to make that might have slight benefits, but the #1 biggest thing that prevents me from exercising as much as I want is having to be in the office 40 hours a week. Also, stress from my job, or boredom at having to sit in front of a computer even when work is slow, is usually what contributes to my unhealthy snacking choices. So if my employer wants me to be healthier they can give me more TIME to work out, buy groceries, and cook.

    6. The OG Anonsie*

      With you on this one.

      This is also a massive sore spot for me and a lot of disabled or chronically ill people for which those regular rules don’t necessarily apply, and this whole nag of “being healthy is your choice” is very frustrating to have to have waved around at you all the time. It also contributes to an overall attitude from other people that our problems must be created or exacerbated by us and our presumably bad choices, making us undeserving of accommodation.

      It’s not that the concept of exercising and eating well is offensive, obviously, but the emphasis on individual choice as universal and in a direct cause & effect relationship with everything that happens to you body. Which is usually the MO of these cheesy goddamn workplace wellness programs– nothing actually constructive or even just basely informative, just subtle shaming and nagging with a lot of moralizing.

  43. Dzhymm*

    I almost wonder if you don’t have health *insurance* per se, but rather your company is self-insured and using the insurance company as a claims processor. That might explain their incredible sensitivity to healthcare claims…

  44. Health Insurance Nerd*

    Your boss is ridiculous. When insurance companies quote policies, they take the demographics of the employer they may be insuring into consideration, the underwriters and actuaries then make certain assumption based on that population, and they quote premiums accordingly. So if there are young women, there will be assumptions about birth control and pregnancy, for folks over 40, there will be assumptions about mammograms and colonoscopies, and on top of all that, the cost of preventive care is also factored in. Yes, if you work for a company where a bunch of people have the unfortunate luck to need major surgeries or cancer treatments, your premiums will likely go up, but for standard “regular” things, all of that cost is already built into the premiums you’re paying.

  45. NW Mossy*

    Oof, not cool, OP’s boss.

    Here’s potentially another angle that might resonate with a tech boss – employee recruitment and retention. The competition for the best staff is extremely fierce, because the talent pool of people with the right skills is small and there are tons of firms looking to hire them.

    In that type of environment, health insurance is a “pay to play” benefit – the best candidates will skip right past a company that doesn’t offer it because they know how expensive it is to get coverage in the individual market. If they were willing to take that risk/expense and they’re highly skilled, they’re more likely to just start their own company rather than join someone else’s for a much smaller equity share.

    Candidates will generally understand if health insurance at a start-up is more expensive and less generous than what bigger competitors offer, but if the insurance benefit is comparatively weaker AND the CEO is railing against people using it, he comes off as clueless about what it takes to get and keep good employees. Good people will leave over this stuff, and it’ll be hard to replace them with equally good or better people. The good ones have way too many other viable options, especially in the current job market.

    Yes, health insurance is a big line item under operating expenses, especially for a tech business with few physical assets. It’s so tempting to try to slash a zero or two off of it. But it’s as necessary to the business’s healthy functioning as a good internet connection or plentiful power outlets. It’s what keeps people well enough to do the knowledge work that gives the company something to sell. Without their healthy, highly functional minds, the company has basically nothing left of value.

  46. BlueDog*

    So, I’m torn about this. On one hand, it feels creepy to feel like someone is intruding on your private medical care.
    On the other hand, the reason health costs have gotten out of control is because the decision to get something done is completely removed from how much it costs. And that’s because the person making the decision isn’t paying for the procedure.

    I’m a physician and I can think of many examples of treatments that I might do (even biopsies) if I didn’t have to pay for them, but wouldn’t if I didn’t.

    Think: “I am 99 percent sure based on your symptoms and appearance that this is nothing, but if you want to be sure, we can biopsy. Otherwise we can watch and wait.”

    “Doc, I want to be absolutely sure, do the biopsy”

    I mean, this isn’t probably the best use of medical dollars and the same patient might not do it if they had to pay out of pocket.

    I think this is more pronounced when all the employees have equity. It really is in their interests to keep costs down.

    I have no problem with making tasteful materials on how to responsibly use the health care system.

    Obviously this doesn’t apply to serious conditions, and life threatening condotions, which again is why info on navigating the health care system is appropriate.

    1. Bea*

      This also falls squarely on the doctors. Even fully insured my medical providers always keep costs low and watch out for me. They do not give an option for a biopsy if they aren’t at least reasonably concerned. Why put a patient through an unnecessary procedure when you can say “we will observe this and see if there’s anything new in a couple months.” if that’s their best choice.

      1. BlueDog*

        I don’t think it’s a matter of best choice. I imagine it’s weighing the cost (monetary, risk, pain, missed work, danger of a wrong diagnosis) of a procedure vs. the the patient’s tolerance for not having 100 percent complete information. And for some people the anxiety can be overwhelming. For those I sometimes recommend a procedure once I explain the risks and benefits. It not uncommon for there to be no “best” option, just multiple equally good (or equally bad) options.

    2. Not a Mere Device*

      Sometimes the cost incentives are perverse: years ago people were surprised that my then-insurance plan would cover more than four physical therapy sessions. It made sense for them to do so—orthopedic surgery is a lot more expensive–but most plan managers didn’t see that.

    3. Observer*

      This is actually not entirely true. It turns out that where the incentives have the most effect is with providers.

      And, as Bea says, a lot of the time the kind of thing described is completely on the doctor. Why are you offering a biopsy if you are 99% sure that it’s nothing? Aside from the cost factor, it’s a bad idea – biopsies are not entirely risk free and even if the patient paid for the biopsy out of pocket (so not affecting insurance) it’s not a useful move. It’s the same thing with antibiotics. For years doctors offered the stuff like candy. And that’s clearly part of the reason we’re seeing trouble with antibiotic resistant bacteria.

      People come to their doctor for guidance. If the doctor offers something and makes it seem like a good idea, then people will generally follow their advice. That’s what the doctor is FOR!

      1. BlueDog*

        It COMPLETELY depends on the patient. Some patients will come and do whatever the doctor says. Some patients bristle at this and will deem you too “paternalistic” for strongly recommending a course of action.
        Some patients don’t want any procedures done, even if it’s not necessarily the best thing for them. Some patients want you to do everything for their piece of mind.
        Maybe I misspoke with the 99% example, but imagine if it’s 90% or 80%. You can’t imagine some people saying, “that 10-20% uncertainty is too much for me, lets deal with this,” and others saying “I’m willing to tolerate 10-20% risk because I really, really don’t want a procedure.” neither is wrong as long at the patient understands the risks of either choice.
        Some people want handholding and some people just want options laid out. People are different. In the end it’s not the doctor’s decision because it isn’t their body.

        1. Observer*

          If the doctor offers an inappropriate choice, then it’s on them if the patient takes them up on it. If it truly is a tossup, then don’t call it an inappropriate use of medical resources.

          1. BlueDog*

            Not saying it’s inappropriate, just saying that choices patients make might be different if they were paying themselves. Right now, for many people, cost isn’t even going into the calculation and it probably should.

            1. Observer*

              Actually, cost is playing into decisions for a LOT, if not most, people. And often to their clear detriment.

              Look at the statistics on people who cut down (or stop) necessary medication or choose a doctor who is a poor fit or doesn’t have the necessary expertise because of cost (they can’t afford to go out of network). Then tell me that most people are making decisions that use more medical care because there is no cost to them.

        2. nonegiven*

          I’d probably have the biopsy on a 10-20% risk it was really something but not on a 99% certainty it wasn’t.

  47. Harper the Other One*

    Could this theoretically even be considered a discriminatory work environment? Essentially, the message being communicated is that people who need medical procedures cost the company money, which by definition means people with disabilities and chronic illnesses are essentially being targeted. It’s not quite the same but it almost feels like saying it would be too expensive to put a grab bar in the bathroom, or get a second monitor for a person with vision problems.

  48. INTP*

    I actually worked for a small company where the owner had a similar attitude. He didn’t go this far, but he told us not to go to the doctor or dentist for silly things or that could threaten our healthcare coverage. We got 5 sick days a year, no one was going to the doctor because they got a new freckle or whatever he thought we were going to do.

    This was brought up again every single time we were commiserating about what a tightwad he was, and it actually contributed to making us feel less of a sense of fiscal responsibility in the company by setting up an antagonistic relationship instead of a cooperative one. We were made to feel like every perk we wanted we were stealing from his pocket, whether that was using our health insurance or drinking from the water cooler. OP, I know you can’t change this guy’s personality but I would strongly urge you to try to use mainstream sources that encourage preventive care and aren’t all “don’t go to the doctor unless you’re already dead!” to minimize the impact on office morale.

  49. Farther and Happier*

    Every year I have to sit thru all the insurance choices that our management provides (50/50 they pay/we pay) And every year they have the same insurance guy who does the insurance choice song and dance. And every year his comments insult me. He tells stories about his own insurance and how he doesn’t use it to try and get us not to use ours. Like the time he tells the story about how his child fell but he refused to take that child to the ER until 24 hrs later when his wife insisted and ta-da his kid had broken their arm. Or the time he told us that we needed to price out our xrays to surrounding areas (some up to 2 hrs away) to get a cheaper price. Even if you didn’t own a car. (many city dwellers don’t own cars.) I get that insurance is a racket and that my company is lucky to even help pay for it. But being insulted by our insurance rep is the one thing that infuriates me every year. You shouldn’t have to “shop around for the best price” when you are having an emergency. You should be able to go to a place and get care. Not a curmudgeonly better than you attitude from your insurance rep. Sorry. This kind of baloney always burns my buttons.

    1. BenAdminGeek*

      That’s so frustrating. There’s a huge difference between “shop around for non-urgent things and consider ways to solve problems outside of immediately rushing to the emergency room” and “ignore actual emergencies and hope they go away” and this guy is way off the charts on the latter.

    2. Observer*

      Wait, he actually uses a case where the kid had a broken arm as an example of when NOT to get an x-ray?! I’m trying to find words to express my reaction that are appropriate to this forum, but it’s hard! I would ask, though, is this guy even reasonably competent?!

    3. Becky*

      There’s a great quote I read somewhere about how healthcare doesn’t follow normal economic supply-demand curves. It was basically nobody price shops when they’re having a heart attack and nobody gets an appendectomy because they’re having a sale.

    4. sigh*

      I wonder if the cost (time, money, productivity) was worth it when cps came knocking. What an idiot. That poor child.

      2. Gazebo Slayer*

        Oh, I’d have reported the smug insurance cheapskate to child protective services myself.

        1. Not So NewReader*

          He could use all the money he saved on xrays to pay for a criminal lawyer and to pay court fines.

    5. The OG Anonsie*

      You can’t even price shop for most things, even if you have CPT codes and call around to different billing departments with your insurance info MOST of the time they’ll refuse to tell you any dollar amounts. And even if you get them, there’s no guarantee that’s how the billing will actually shake out when a claim is processed.

      1. Judy (since 2010)*

        And even when it’s something you should be able to price shop, like prescriptions, they don’t make it easy.

        Our pharmacy benefit manager has a way to check prices at different pharmacies for the same drug on their website. But you have to pick the pharmacy, then pick the drug and dosage. And repeat to pick the next pharmacy. Wouldn’t people usually want to pick the drug and dosage, then see a list of the pharmacies in the area with the costs?

  50. Knitting Cat Lady*

    Oh dear.

    I have chronic health issues. Those health issues are considered a disability.

    I have to see at least two doctors every quarter as I need a ton of medication to manage my chronic health issues.

    And I need regular blood tests and ECGs to check if the medication isn’t doing my liver, kidneys or heart in.

    My chronic health issues also mean that I’m immune compromised. I catch just about every bug there is.

    So, me avoiding using my insurance would mean a lengthy hospital stay down the road since paying out of pocket for my meds and other stuff would be rather expensive.

    Using German prices no less!

    Luckily for me I’m in the German Public Health Care System and what I pay stays the same no matter what and only changes when the government adjusts the rates.

  51. E*

    While I recognize this is a huge overstep by the boss, I will also admit to making a lot of health choices that I wouldn’t if I were paying out of pocket.

    For example, I have great prescription coverage. I have a minor issue that requires regular medication. There is a genetic drug available ($6/month) and a slightly different formulation that’s branded ($1750/month). The latter can be taken right before bed, which I slightly prefer, while the former you need to stay upright for half an hour. The out of pocket cost to me is very similar, so I take the branded. I would never, ever do this if I were bearing more of the cost or thinking more like an owner of my company.

    Likewise, a family member who’s on my plan has been having regular allergy shots despite not necessarily believing they’re helpful. If we were paying more than a tiny copay, he’d stop them.

    I have several other examples like this.

    1. Observer*

      Your family member is a total outlier. I also suspect that there is more to the story that your family member may not be sharing. I say this because there is more to allergy shots than the cost of the shots (or the copay).

      As for your case, that’s also pretty unusual. Every prescription plan I have seen (even really good ones) have a significant penalty for using the branded drug rather than the generic. Yes, there are some exceptions within the plan but you have to dig for them. And you’re not getting those exceptions for your convenience. So, treasure your insurance plan. And hope that they don’t decide to jack up the price to a point that you / your employer can’t pay for it anymore. (And I get that this could happen regardless of your usage. I’m not trying to point a finger. Just commenting on how uncommon it is.)

      1. E*

        Yeah, my prescription coverage is pretty exceptional. As long as a drug is covered, my contribution caps out at a very low number. Generic is still cheaper, but with coupons on the branded, they’re very, very close.

        On the allergy shots, there really isn’t much more to the story. Before we were married and he was on my plan, his doctor offered the allergy shots but said he wasn’t optimistic they’d help. On his old plan, my husband would have had to pay a lot for them, so just ignored this option for years. As soon as he was on mine, he gave it a try. He doesn’t think they’re making more than a tiny difference, and if someone told him/us he’d need to pay anything over, say, $50/year for them, he’d stop. But for now, he’s continuing with the shots and my insurance is paying out the nose.

        1. Observer*

          OK, still an outlier. It’s highly untypical for people to get shots on a regular basis, as well as taking the time and effort to do this, for something they think doesn’t help. I thinks it’s a major mistake to base health policy on the outliers.

  52. BenAdminGeek*

    Your boss has some good things and some terrible things going on here. It’s a good thing to encourage people to make better health care decisions, and the guides are actually incredibly useful for a lot of folks. My company does reminders and things helping us understand impact, and it’s impactful.

    However, it’s a terrible idea to focus on usage as the issue, and make comments about that. There’s actually a recent court case where this sort of stuff came back to bite a company- Stein v. Atlas Industries, Inc., No. 17-3737. Regardless of whether Americans go to the doctor too quickly (many do!), that’s not a specific avenue that you want to call out as CEO to criticize your employees on specifically.

    1. Kathleen_A*

      I agree very strongly that he’s doing both good things and bad things here. Learning when you need to go to a doctor and when you do not is a very valuable life skill that will save you and the health care system time and money – and unnecessary health care. (And yes, sister #1, I am thinking about you and your contention that you need antibiotics every time you catch a cold, and yes, also about you, SIL #1, and your *weekly* visits to your chiropractor that supposedly help your asthma.) But hinting that if you’re young and healthy, you automatically do not need to go to a doctor is…not so good.

      It’s very hard to tell from the letter of the guy is clueless about healthcare and over-invested in saving the company money, or if he is just very, very clumsy at communicating. Because it actually is possible that he really didn’t need that biopsy. Who here can say?

  53. sigh*

    How is this impacting how he treats or if he hires people with disabilities who he likely views as bigger consumers of health care? I have ehlers danlos and an autoimmune disease, and multiple people have mentioned to me how “people like me” drive up healthcare costs. Good to know my life and wellbeing is so inconvenient for penny obsessed crazies.

    1. The OG Anonsie*

      Yeah I would almost guarantee you this dude wouldn’t hire someone with a disability if he knew about it ahead of time.

      1. Two-Time College Dropout*

        Probably means he’s less likely to hire older people, fat people, and women too.

    2. A Person*

      I bet guys like this are looking to screen out people who don’t look healthy during the interview process. Maybe they make people sit for hours without food or drink just to see…

      I look healthy but that’s due to the great (and expensive, and medically necessary) care I receive. It’s been disturbing lately to hear just how many people would rather see me suffer and die than have their costs go up a tiny fraction so I can remain a productive member of the workforce.

  54. Mr. Bob Dobalina*

    To sum up, we have a CEO who actively discourages employees from using the health insurance, 80 employees and no HR. I conclude that it’s about time to hire an experienced HR person. As a side note, beware if the CEO is using the “we’re just a start-up company” excuse for deficiencies. This excuse will go on and on and one day you will suddenly realize that the company is publicly traded, has revenue, has 100+ employees, has been around for years, and… oops, no longer meets anyone’s definition of a start-up.

  55. The OG Anonsie*

    Obligatory note that young people can also be chronically ill/disabled, youth is not an indicator of health.

    1. Jennifer Thneed*

      Thank you! Just yesterday a friend was telling me about how her daughter had saved a coworker’s life because she noticed that he seemed “off”. It turned out that he’d just had a stroke. He went to the hospital and had another stroke in the operating room. He’s alive after all this and will be needing rehab for awhile. He’s 21 years old.

  56. yet another Kat*

    This seems like it would create a hostile work environment for anyone with chronic illness or with mental illness. As a relatively young person who “appears healthy” on the outside but has had to have multiple surgeries and has to have a lot of scans and tests on a regular basis, working somewhere like this would give me tons of anxiety. I’m sure that someone using this insurance to support their mental health through therapy and.or prescription meds would also be really uncomfortable with this boss.

    I will say that I personally am also pretty leery of company health initiatives because the same foods and activities that are encouraged as healthy for some may not be for others, and the negatives of putting people in a position where they have to publicly opt out outweigh any potential positive results, imo.

    1. ExcelJedi*

      “I will say that I personally am also pretty leery of company health initiatives because the same foods and activities that are encouraged as healthy for some may not be for others”

      This. All of this.

      Additionally, they may be triggering for anyone with an eating disorder or disordered body image/relationship with exercise/etc. It can be really dangerous for lots of people to be trapped in an environment with those.

      1. The OG Anonsie*

        Hell, I have mobility problems and little initiatives like trying to get everyone to take more steps or take the stairs more are done problematically an overwhelming majority of the time.

        You might say “well that’s not fair, not everything can apply to everyone– by those standards, there’s no way for a workplace to do a health-based initiative!” And for the most part, yeah, exactly, your workplace really shouldn’t be doing stuff like this. But it still wouldn’t be hard to do a non-specific promotion that allows people to choose a range of individual goals without moralizing. Basically, no one thinks they should have to take us into account because it requires thought and effort. Boo hoo.

  57. RUKiddingMe*

    “…refused to get something biopsied because of the cost.”

    I bet it was because of his part of the cost.

  58. Triple Anon*

    Reading all of the comments, I’m noticing that this isn’t an isolated incident. A lot of companies are stressed about the cost of insurance. So the bigger picture issue here (or one of them) is that health Care is becoming more expensive in the United States. There are reasons for that, but that’s pretty much the extent of what I know. Anyway, it would be interesting to look into the factors contributing to this.

    As for the letter, you could use the writing assignment as a way to address the issue. I like another commenter’s suggestion of consulting an outside agency. In the writing itself, you could also very clearly stipulate the limitations of the advice. (“This does not apply to people with chronic illnesses, test for conditions that could be serious,” etc). But it is creepy. I’d be looking for another job.

  59. Liz*

    Contact a local medical library/librarian and ask for sources for the info your boss wants. Legit advice will help!

Comments are closed.